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] } ] }, { "description": "Metronidazole 500 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "42292-0001-20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.60, "discounted_cash": 1.30, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Memantine 5 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "42292-0005-06", 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"description": "Dorzolamide ophth 2% sol 10 ml", "drug_information": { "unit": "10.00", "type": "UN" }, "code_information": [ { "code": "42571-0141-26", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 180.36, "discounted_cash": 90.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Celecoxib 100 mg cap", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": 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"methodology": "percent of total billed charges" } ] } ] }, { "description": "Clarithromycin 500 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "50268-0179-13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.67, "discounted_cash": 10.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 17.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Doxycycline monohydrate 100 mg oral cap", "drug_information": { 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"estimated_amount": 3.90, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocortisone 25 mg supp", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "50268-0411-12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 44.70, "discounted_cash": 22.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 35.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 35.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 35.76, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocortisone 25 mg supp", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "50268-0411-24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 66.65, "discounted_cash": 33.33, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 53.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 53.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 53.32, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Isosorbide dinitrate 10 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "50268-0448-15", "type": "NDC" } ], "standard_charges": 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"standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amlodipine 2.5 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "51079-0450-20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.36, "discounted_cash": 2.68, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amlodipine 10 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "51079-0452-20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.35, "discounted_cash": 3.68, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5.88, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fluphenazine 2.5 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "51079-0486-20", "type": "NDC" } ], "standard_charges": [ 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"standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Glipizide 5 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "51079-0810-20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.60, "discounted_cash": 1.30, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Levetiracetam 500 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"methodology": "percent of total billed charges" } ] } ] }, { "description": "Metoclopramide 10 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "51079-0888-20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.98, "discounted_cash": 1.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2.38, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Nifedipine 60 mg er tab", "drug_information": { "unit": "1.00", "type": 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"percent of total billed charges" } ] } ] }, { "description": "Propafenone 150 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "51079-0996-20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.21, "discounted_cash": 2.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4.17, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tizanidine 4 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, 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"standard_charge_percentage": 80.0, "estimated_amount": 12.13, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Morphine 15 mg er tab ud", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68084-0403-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.70, "discounted_cash": 2.85, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4.56, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Divalproex sodium 500 mg er tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68084-0415-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.87, "discounted_cash": 5.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9.50, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydromorphone 2 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68084-0423-01", "type": "NDC" } ], 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} ] } ] }, { "description": "Ethambutol 100 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68180-0280-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.60, "discounted_cash": 1.30, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2.08, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Duloxetine 30 mg cap", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68180-0295-06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.34, "discounted_cash": 12.17, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 19.47, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19.47, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19.47, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Duloxetine 30 mg cap", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68180-0295-09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.34, "discounted_cash": 12.17, "setting": "both", "payers_information": [ { "payer_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 22.22, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Losartan 25 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68180-0376-09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.21, "discounted_cash": 2.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4.17, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Losartan 50 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68180-0377-09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.01, "discounted_cash": 3.51, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5.61, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5.61, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Losartan 100 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "68180-0378-09", "type": "NDC" } ], "standard_charges": [ { 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} ] }, { "description": "Valsartan 160 mg tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "00378-5814-77", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.16, "discounted_cash": 8.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.93, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Digoxin 125 mcg (0.125 mg) tab", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": 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80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, 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"plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": 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Preferred", "plan_name": "29030781", "standard_charge_dollar": 69.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 69.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1238.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1263.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1263.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1238.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1238.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1238.91, 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"payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Ncntc r-t fluor wnd img 1st", "code_information": [ { "code": "0598T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 648.00, "discounted_cash": 324.00, "minimum": 317.79, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", 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"plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 518.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 518.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "0599t moleculight additional wound(s) techfee", "code_information": [ { "code": "0599T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 673.00, "discounted_cash": 336.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 538.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 538.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 538.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ncntc r-t fluor wnd img ea", "code_information": [ { "code": "0599T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 673.00, "discounted_cash": 336.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 538.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 538.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 538.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "0614t- removal/replacement substernal implantable defibrillator pulse generator tech fee", "code_information": [ { "code": "0614T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 51947.00, "discounted_cash": 25973.50, "minimum": 22906.87, "maximum": 23365.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 22906.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 23365.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 23365.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 22906.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 22906.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 22906.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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"standard_charge_dollar": 22906.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 41557.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 41557.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 22906.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 22906.87, "methodology": "fee schedule" } ] } ] }, { "description": "Rmvl&rplcmt ss impl dfb pg", "code_information": [ { "code": "0614T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 51947.00, "discounted_cash": 25973.50, "minimum": 22906.87, "maximum": 23365.01, "setting": "both", 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billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 224.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Ncntc ifr spctrsc o/t pad 1", "code_information": [ { "code": "0640T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 280.00, "discounted_cash": 140.00, "minimum": 40.06, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, 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Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ncntc ifr spctrsc o/t pad ea", "code_information": [ { "code": "0859T", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 41.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fna bx w/us gdn 1st les", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 874.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 874.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Fna bx w/us gdn ea addl", "code_information": [ { "code": "10006", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1347.00, "discounted_cash": 673.50, "minimum": 1205.92, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1077.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1077.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1077.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fna bx w/fluor gdn 1st les", "code_information": [ { "code": "10007", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1091.00, "discounted_cash": 545.50, "minimum": 718.03, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 872.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 872.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 872.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Fna bx w/fluor gdn ea addl", "code_information": [ { "code": "10008", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1347.00, "discounted_cash": 673.50, "minimum": 1205.92, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1077.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1077.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1077.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "10021 fine needle aspiration w/o imaging guidance; first lesion", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 863.00, "discounted_cash": 431.50, "minimum": 407.73, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Fna bx w/o img gdn 1st les", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 863.00, "discounted_cash": 431.50, "minimum": 407.73, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Acne surgery", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41174.97, "discounted_cash": 20587.49, "minimum": 202.78, "maximum": 1032.35, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 762.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1032.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 32939.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 32939.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "10060 incision & drainage of abscess (carbuncle suppurative hidradenitis cyst cutaneous or subcut", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 1032.35, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32721.52, 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Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "10061 incision & drainage of abscess: complicated / multiple", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32721.52, "discounted_cash": 16360.76, "minimum": 407.73, "maximum": 1032.35, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 26177.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 26177.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 26177.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 427.50, "minimum": 407.73, "maximum": 1032.35, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 762.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1032.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": 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"standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "10080 incision and drainage of pilonidal cyst; simple", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1508.00, "discounted_cash": 754.00, "minimum": 628.32, "maximum": 1032.35, "setting": 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"29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": 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"standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 762.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1032.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, 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}, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20821.50, "methodology": "percent of total billed charges" } ] } ] }, { "description": "11001 debridement small charge", "code_information": [ { "code": "11001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 558.02, "maximum": 916.84, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 52940.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 718.03, 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"standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 35052.16, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 35052.16, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] 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"standard_charge_dollar": 916.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { 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1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 31559.31, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 31559.31, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": 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"payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "11056 paring or cutting of benign hyperkeratotic lesion: 2 - 4 lesions tech", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 916.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 677.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 916.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Trim skin lesions 2 to 4", "code_information": [ { "code": "11056", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 916.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 677.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 916.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "11057 paring or cutting of benign hyperkeratotic lesion: more than 4 lesions", "code_information": [ { "code": "11057", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 916.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 677.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 916.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 677.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 916.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Tangntl bx skin single les", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10706.83, "discounted_cash": 5353.42, "minimum": 202.78, "maximum": 3216.93, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8565.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", 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"plan_name": "29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 34799.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", 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schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5635.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2920.79, "methodology": 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"standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 42316.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 42316.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Exc tr-ext mal+marg 0.5 cm/<", "code_information": [ { "code": "11600", "type": "CPT" } ], "standard_charges": [ 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"payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Exc tr-ext mal+marg 1.1-2 cm", "code_information": [ { "code": "11602", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50703.69, "discounted_cash": 25351.85, "minimum": 407.73, "maximum": 3216.93, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": 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407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Exc tr-ext mal+marg 2.1-3 cm", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50703.69, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 40562.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Exc tr-ext mal+marg 2.1-3 cm", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6380.83, "discounted_cash": 3190.42, "minimum": 718.03, "maximum": 3216.93, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5104.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5104.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5104.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Exc tr-ext mal+marg 3.1-4 cm", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50703.69, "discounted_cash": 25351.85, "minimum": 718.03, "maximum": 3216.93, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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"fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5937.85, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5937.85, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "11720 debride nail 1-5 tech fee", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 65.00, "minimum": 60.62, "maximum": 320.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 237.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 320.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Debride nail 1-5", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 65.00, "minimum": 60.62, "maximum": 320.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 237.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 320.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "11721 debride nail 6 or more tech fee", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 65.00, "minimum": 60.62, "maximum": 320.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 237.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 320.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Debride nail 6 or more", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 65.00, "minimum": 60.62, "maximum": 320.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 237.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 320.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "11730 avls nail plt sngl ed charge", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 415.00, "discounted_cash": 207.50, "minimum": 202.78, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of nail plate", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 415.00, "discounted_cash": 207.50, "minimum": 202.78, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "11732 avulsion of nail plate; each additional nail plate", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Remove nail plate add-on", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "11740 evacuation of subungual hematoma", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 137.50, "minimum": 131.55, "maximum": 320.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 237.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 320.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Drain blood from under nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 137.50, "minimum": 131.55, "maximum": 320.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 237.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 320.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "11750 excision of nail and nail matrix partial or complete for permanent removal", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 427.50, "minimum": 407.73, "maximum": 3216.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of nail bed", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 427.50, "minimum": 407.73, "maximum": 3216.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "11760 repair nail bed techfee", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1213.00, "discounted_cash": 606.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Repair of nail bed", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1213.00, "discounted_cash": 606.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "11765 wedge excision skin nail fold techfee", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.00, "discounted_cash": 58.50, "minimum": 407.73, "maximum": 916.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 677.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 916.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": 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"standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 677.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 916.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Remove pilonidal cyst simple", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8475.18, "discounted_cash": 4237.59, "minimum": 2920.79, "maximum": 6640.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4907.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6640.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6780.14, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6780.14, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6780.14, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69333.55, "discounted_cash": 34666.78, "minimum": 2920.79, "maximum": 6640.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4907.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6640.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 55466.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 55466.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 55466.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7935.35, "discounted_cash": 3967.68, "minimum": 2920.79, "maximum": 6640.00, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4907.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6640.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": 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"30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 663.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 663.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans 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580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare 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Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, 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"plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total 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"methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12396.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12396.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12396.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr 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"methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous 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"standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12396.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12396.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12396.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12011 simple repair f/e/e/n/l/m 2.5cm/< techfee", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14900.24, "discounted_cash": 7450.12, "minimum": 202.78, "maximum": 953.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12011 simple repair f/e/e/n/l/m 2.5cm/< techfee", 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"28186640", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", 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{ "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr f/e/e/n/l/m 2.5 cm/<", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 420.00, "discounted_cash": 210.00, "minimum": 202.78, "maximum": 953.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12013 simple repair f/e/e/n/l/m 2.6cm-5.0 cm techfee", "code_information": [ { "code": "12013", "type": "CPT" } ], 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"estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12013 simple repair f/e/e/n/l/m 2.6cm-5.0 cm techfee", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 420.00, "discounted_cash": 210.00, "minimum": 202.78, "maximum": 953.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", 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{ "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr f/e/e/n/l/m 2.6-5.0 cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14900.24, "discounted_cash": 7450.12, "minimum": 202.78, "maximum": 953.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr f/e/e/n/l/m 2.6-5.0 cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 420.00, 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"fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 336.00, "methodology": "percent of total 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schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", 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"standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12014 proc wound repair 12014 ed charge", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 410.00, "discounted_cash": 205.00, "minimum": 202.78, "maximum": 953.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": 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953.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr f/e/e/n/l/m 5.1-7.5 cm", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 410.00, "discounted_cash": 205.00, "minimum": 202.78, "maximum": 953.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12015 simple repair f/e/e/n/l/m 7.6cm-12.5 cm techfee", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14900.24, "discounted_cash": 7450.12, "minimum": 202.78, "maximum": 953.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12015 simple repair f/e/e/n/l/m 7.6cm-12.5 cm techfee", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 405.00, "discounted_cash": 202.50, "minimum": 202.78, "maximum": 953.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 324.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 324.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 324.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr f/e/e/n/l/m 7.6-12.5 cm", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14900.24, "discounted_cash": 7450.12, "minimum": 202.78, "maximum": 953.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr f/e/e/n/l/m 7.6-12.5 cm", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 405.00, "discounted_cash": 202.50, "minimum": 202.78, "maximum": 953.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 324.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 324.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 324.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "12016  repair simple 12.6-20.0cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 315.00, "discounted_cash": 157.50, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 252.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 252.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 252.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr fe/e/en/l/m 12.6-20.0 cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 315.00, "discounted_cash": 157.50, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 252.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 252.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 252.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": 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"fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11920.19, 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"plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": 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"29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr s/a/t/ext 2.5 cm/<", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6170.93, "discounted_cash": 3085.47, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4936.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4936.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4936.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr s/a/t/ext 2.6-7.5", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6608.78, "discounted_cash": 3304.39, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5287.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5287.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5287.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "12034 repair intermediate s/a/t/e 7.6-12.5 cm techfee", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 407.73, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr s/tr/ext 7.6-12.5", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 407.73, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "12035 closure of wounds of scalp axillae trunk extremities(exclude hands and feet) 12.6 cm to 20", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 878.00, "discounted_cash": 439.00, "minimum": 407.73, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 702.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 702.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 702.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr s/a/t/ext 12.6-20", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 878.00, "discounted_cash": 439.00, "minimum": 407.73, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 702.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 702.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 702.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "12036 repair intermediate s/a/t/e 20.1-30.0 cm techfee", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1385.00, "discounted_cash": 692.50, "minimum": 624.69, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr s/a/t/ext 20.1-30", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1385.00, "discounted_cash": 692.50, "minimum": 624.69, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "12041 closure of wounds of neck hands feet and/or ext genitalia; 2.5 cm > ed charge", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 818.00, "discounted_cash": 409.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr n-hf/genit 2.5cm/<", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 818.00, "discounted_cash": 409.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr n-hf/genit2.6-7.5", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7105.87, "discounted_cash": 3552.94, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5684.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5684.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5684.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "12044 closure of wounds of neck hands feet and/or ext genitalia; 7.6 cm to 12.5 cm ed charge", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1343.00, "discounted_cash": 671.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1074.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1074.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1074.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr n-hf/genit7.6-12.5", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1343.00, "discounted_cash": 671.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1074.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"type": "CPT" } ], "standard_charges": [ { "gross_charge": 6157.04, "discounted_cash": 3078.52, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": 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"methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4925.63, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "12052 closure of wounds of face ear eyelid nose lip mucous membrane 2.6 cm to 5.0 cm ed charge", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 800.00, "discounted_cash": 400.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr face/mm 2.6-5.0 cm", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 800.00, "discounted_cash": 400.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr face/mm 5.1-7.5 cm", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6959.83, "discounted_cash": 3479.92, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5567.86, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5567.86, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5567.86, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "12054 closure of wounds of face ear eyelid nose lip mucous membrane 7.6 cm to 12.5 cm ed charge", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 818.00, "discounted_cash": 409.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Intmd rpr face/mm 7.6-12.5cm", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 818.00, "discounted_cash": 409.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 654.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "13121 repair complex scalp/arm/leg 2.6-7.5 cm techfee", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1213.00, "discounted_cash": 606.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Cmplx rpr s/a/l 2.6-7.5 cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1213.00, "discounted_cash": 606.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 970.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "13122 repair complex scalp/arm/leg ea addl 5 cm/< techfee", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cmplx rpr s/a/l addl 5 cm/>", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "13132 proc wound repair 13132 ed charge", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1385.00, "discounted_cash": 692.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Cmplx rpr f/c/c/m/n/ax/g/h/f", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1385.00, "discounted_cash": 692.50, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "13133 complex forehead/cheek/mouth/neck/axillae/genitalia/hands/feet each additional 5cm> ed charge", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 875.00, "discounted_cash": 437.50, "minimum": 1541.74, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 700.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 700.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 700.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cmplx rpr f/c/c/m/n/ax/g/h/f", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 875.00, "discounted_cash": 437.50, "minimum": 1541.74, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 700.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 700.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 700.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "13152 repair comp nose/eye 2.6-7.5cm", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1385.00, "discounted_cash": 692.50, "minimum": 624.69, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Cmplx rpr e/n/e/l 2.6-7.5 cm", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1385.00, "discounted_cash": 692.50, "minimum": 624.69, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Tis trnfr f/c/c/m/n/a/g/h/f", "code_information": [ { "code": "14041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9268.18, "discounted_cash": 4634.09, "minimum": 1866.77, "maximum": 9138.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7414.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7414.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7414.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Tis trnfr e/n/e/l 10 sq cm/<", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7355.98, "discounted_cash": 3677.99, "minimum": 1866.77, "maximum": 9138.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5884.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5884.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5884.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Tis trnfr any 30.1-60 sq cm", "code_information": [ { "code": "14301", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8515.53, "discounted_cash": 4257.77, "minimum": 3736.11, "maximum": 9138.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6812.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": 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"standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Wnd prep f/n/hf/g addl cm", "code_information": [ { "code": "15005", "type": "CPT" } ], "standard_charges": [ { 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"methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "15100 split-thickness auto graft clinic charge", "code_information": [ { "code": "15100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 1866.77, "maximum": 9138.78, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Skin splt grft trnk/arm/leg", "code_information": [ { "code": "15100", "type": "CPT" } ], "standard_charges": [ 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24919.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 24919.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Skin splt grft trnk/arm/leg", "code_information": [ { "code": "15100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 1866.77, "maximum": 9138.78, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "15110 epidermal autograft trunk arms legs; first 100 sq cm or less", "code_information": [ { "code": "15110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 1866.77, "maximum": 9138.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Epidrm autogrft trnk/arm/leg", "code_information": [ { "code": "15110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 1866.77, "maximum": 9138.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Epidrm autogrft t/a/l add-on", "code_information": [ { "code": "15111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31148.98, "discounted_cash": 15574.49, "minimum": 5562.12, "maximum": 9138.78, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 24919.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 24919.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 24919.18, "methodology": "percent of total billed charges" } ] } ] }, { "description": "15115 epidermal agrft f/s/n/h/f/g/m/d gt 1st 100 cm/<", "code_information": [ { "code": "15115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 1866.77, "maximum": 9138.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Epidrm a-grft face/nck/hf/g", 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schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 24919.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 24919.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 24919.18, "methodology": "percent of total billed charges" } ] } ] }, { "description": "15120 split thickness autograft f/h/ft 1st 100 sq cm techfee", "code_information": [ { "code": "15120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7525.01, "discounted_cash": 3762.51, "minimum": 3736.11, "maximum": 9138.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6754.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9138.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { 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"payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6020.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6020.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" } ] } ] }, { "description": "Skn splt a-grft fac/nck/hf/g", 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{ "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6020.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", 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schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Cult skin grft t/arm/leg", "code_information": [ { "code": "15150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31148.98, "discounted_cash": 15574.49, "minimum": 1866.77, "maximum": 9138.78, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5562.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7946.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", 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charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Skin sub graft t/a/l add-on", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { 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5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3810.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6648.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6648.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6648.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" } ] } ] }, { "description": "15274 app skn sub grft t/a/l area>=100scm adl 100sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7690.00, "discounted_cash": 3845.00, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6152.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6152.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6152.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Skn sub grft t/a/l child add", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7690.00, "discounted_cash": 3845.00, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6152.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6152.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6152.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "15275 app of skin sub graft wound area up to 100 sq cm first 25sq cm or less", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4045.00, "discounted_cash": 2022.50, "minimum": 1866.77, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Skin sub graft face/nk/hf/g", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4045.00, "discounted_cash": 2022.50, "minimum": 1866.77, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "15276 wc each additional 25sqcm skin sub graft face/scalp/feet", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Skin sub graft f/n/hf/g addl", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "15277- sub grft f/s/n/h/f/g/m/d >= 100scm 1st 100sq cm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4045.00, "discounted_cash": 2022.50, "minimum": 1866.77, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "Skn sub grft f/n/hf/g child", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4045.00, "discounted_cash": 2022.50, "minimum": 1866.77, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3236.00, 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"standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 6655.30, "methodology": "fee schedule" } ] } ] }, { "description": "Remove sutures diff surgeon", "code_information": [ { "code": "15851", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6522.05, "discounted_cash": 3261.03, "minimum": 1866.77, "maximum": 6640.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4907.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6640.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee 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"payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5217.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5217.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "15853 removal of sutures w/o anesthesia", "code_information": [ { "code": "15853", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 37.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Removal sutr/stapl xreq anes", "code_information": [ { "code": "15853", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 37.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69333.55, "discounted_cash": 34666.78, "minimum": 2920.79, "maximum": 10240.30, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 6232.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8904.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8904.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6232.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7568.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10240.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 55466.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 55466.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "Remove 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}, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3736.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 42210.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 42210.37, "methodology": "percent 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"standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 37253.91, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 37253.91, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 37253.91, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "16000 initial treatment of burns clinic", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 206.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Initial treatment of burn(s)", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 206.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "16020 dressing an/or debmt partial thn burn initial or subsequent small", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26026.88, "discounted_cash": 13013.44, "minimum": 202.78, "maximum": 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"plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 20821.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20821.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20821.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "16020 dressing an/or debmt partial thn burn initial or subsequent small", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 259.23, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, 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"standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20821.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20821.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Dress/debrid p-thick burn s", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 259.23, "setting": "outpatient", 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"standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Dress/debrid p-thick burn l", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 427.50, "minimum": 259.23, "maximum": 415.88, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 259.23, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Destruct b9 lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7057.70, "discounted_cash": 3528.85, "minimum": 202.78, "maximum": 916.84, "setting": "both", "payers_information": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5646.16, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5646.16, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5646.16, 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"methodology": "fee schedule" } ] } ] }, { "description": "Chem caut of granltj tissue", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 916.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 797.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 558.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 677.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": 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Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 23326.77, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 23326.77, "methodology": "percent of total billed charges" }, { 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1336.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Incision of breast lesion", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23781.42, "discounted_cash": 11890.71, "minimum": 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{ "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5443.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" } ] } ] }, { "description": "Biopsy of breast open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10159.77, "discounted_cash": 5079.89, "minimum": 3907.87, "maximum": 3986.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3907.87, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8127.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8127.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8127.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7711.54, "discounted_cash": 3855.77, "minimum": 3151.15, "maximum": 5177.46, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3151.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4502.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4502.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3151.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 3826.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5177.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare 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Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6169.23, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6169.23, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7711.54, "discounted_cash": 3855.77, "minimum": 3907.87, "maximum": 3986.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3907.87, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { 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"payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6169.23, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6169.23, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" } ] } ] }, { "description": "Ma breast ndl loc placement lt", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", 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1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "Perq dev breast 1st us imag", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1285.00, "discounted_cash": 642.50, "minimum": 126.87, "maximum": 732.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1028.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1028.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1028.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 718.03, "methodology": "fee schedule" } ] } ] }, { "description": "Us breast ndl loc lt", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1285.00, "discounted_cash": 642.50, "minimum": 126.87, "maximum": 732.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": 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3907.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3907.87, "methodology": "fee schedule" } ] } ] }, { "description": "Partial mastectomy", "code_information": [ { "code": "19301", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13912.77, "discounted_cash": 6956.39, "minimum": 3907.87, "maximum": 3986.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3907.87, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3986.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3907.87, "methodology": "fee 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] }, { "description": "Bone biopsy open superficial", "code_information": [ { "code": "20240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 2920.79, "maximum": 6640.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4907.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "20520 removal foreign body muscle/tendon sheath simple techfee", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6263.00, "discounted_cash": 3131.50, "minimum": 1653.49, "maximum": 3216.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 38879.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 38879.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 301.25, "methodology": "fee schedule" } ] } ] }, { "description": "20552 inj trigger point 1/2 muscl-ed pf", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 307.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 307.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 484.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 484.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 484.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 301.25, "methodology": "fee schedule" } ] } ] }, { "description": "Inj trigger point 1/2 muscl", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 605.00, "discounted_cash": 302.50, "minimum": 301.25, "maximum": 1296.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 788.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1127.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1127.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 788.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 957.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1296.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 307.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 307.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 484.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 484.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 484.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 301.25, "methodology": "fee schedule" } ] } ] }, { "description": "20560 dry needling for 1-2 muscles", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 63.00, "discounted_cash": 31.50, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Ndl insj w/o njx 1 or 2 musc", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 63.00, "discounted_cash": 31.50, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "20561 dry needling for 3 or more muscles", "code_information": [ { "code": "20561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 30.00, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Ndl insj w/o njx 3+ musc", "code_information": [ { "code": "20561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 30.00, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50149.48, "discounted_cash": 25074.74, "minimum": 301.25, "maximum": 1296.12, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 788.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1127.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1127.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 788.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 957.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1296.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 307.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 307.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 40119.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 40119.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 40119.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 301.25, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 301.25, "methodology": "fee schedule" } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3716.88, "discounted_cash": 1858.44, "minimum": 301.25, "maximum": 1296.12, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 788.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1127.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1127.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 788.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", 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}, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 114835.47, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 114835.47, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Exc face les sc <2 cm", "code_information": [ { "code": "21011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5962.90, "discounted_cash": 2981.45, "minimum": 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2504.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2504.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" } ] } ] }, { "description": "Closed tx nose fx w/o stablj", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3130.00, "discounted_cash": 1565.00, "minimum": 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"Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1541.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1541.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2504.00, "methodology": "percent of total billed charges" }, { 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Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2504.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" } ] } ] }, { "description": "Closed tx nose fx w/ stablj", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5717.70, "discounted_cash": 2858.85, "minimum": 3309.63, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 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"standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4574.16, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4574.16, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "21480 closed tx temporomandibular dislocation 1st/sbsq techfee", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 244.00, "minimum": 244.80, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": 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schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Reset dislocated jaw", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 244.00, "minimum": 244.80, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"plan_name": "29030748", "standard_charge_dollar": 9272.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6490.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7881.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10663.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 27057.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 27057.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 27057.90, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Exc neck les sc 3 cm/>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6235.53, "discounted_cash": 3117.77, "minimum": 1957.92, "maximum": 3216.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4988.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4988.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4988.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "Exc neck tum deep 5 cm/>", "code_information": [ { "code": "21554", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32045.23, "discounted_cash": 16022.62, "minimum": 1957.92, "maximum": 3216.93, "setting": "inpatient", 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"standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 25636.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": 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] }, { "description": "Exc shoulder tum deep 5 cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5665.00, "discounted_cash": 2832.50, "minimum": 1957.92, "maximum": 3216.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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}, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48849.91, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48849.91, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "Exc shoulder tum deep < 5 cm", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6862.02, "discounted_cash": 3431.01, "minimum": 2920.79, "maximum": 6640.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5489.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5489.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } 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"standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "Partial removal collar bone", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15659.47, "discounted_cash": 7829.74, "minimum": 3311.20, "maximum": 10663.43, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 6490.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 9272.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 9272.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6490.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7881.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10663.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12527.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12527.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12527.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of collar bone", 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schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United 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"payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 416.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 416.00, "methodology": "percent of total 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Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "23655 clsed trtmnt shoulder dislocation ed charge", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3220.00, "discounted_cash": 1610.00, "minimum": 1633.26, "maximum": 3752.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2283.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3262.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3262.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2283.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2773.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3752.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1665.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1665.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1633.26, "methodology": 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"payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12100.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" 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"standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "23931 incision and drainage upper arm or elbow area; bursa techfee", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3468.00, "discounted_cash": 1734.00, "minimum": 1246.80, "maximum": 2048.54, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1246.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1781.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1781.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1246.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1514.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2048.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2774.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2774.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2774.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "Drainage of arm bursa", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3468.00, "discounted_cash": 1734.00, "minimum": 1246.80, "maximum": 2048.54, "setting": 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"29045832", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2774.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2774.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2774.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "Exc arm/elbow les sc 3 cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75070.10, "discounted_cash": 37535.05, "minimum": 1957.92, "maximum": 3216.93, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2979.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "Exc arm/elbow les sc < 3 cm", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75070.10, "discounted_cash": 37535.05, "minimum": 1653.49, "maximum": 6640.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5773.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4041.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4907.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6640.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60056.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "Resect arm/elbow tum < 5 cm", "code_information": [ { "code": "24077", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75070.10, "discounted_cash": 37535.05, "minimum": 2920.79, "maximum": 10240.30, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 6232.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8904.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8904.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6232.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7568.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10240.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", 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} ] }, { "description": "24640 -closed tx radial head sublux child/ nursemaid elbow w/ manipulation er tech", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 244.00, "minimum": 244.80, "maximum": 2010.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1485.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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"payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total 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"payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "25565 closed tx 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"standard_charge_dollar": 2010.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1665.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1665.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1633.26, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 35022.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 35022.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" } ] } ] }, { "description": "Treat 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"29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "25680 closed treatmenttrans-scaphoperilunar typefracture disloc w/ manip techfee", "code_information": [ { "code": "25680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 244.00, "minimum": 244.80, "maximum": 2010.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { 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{ "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Amputation of hand", "code_information": [ { "code": "25927", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10300.52, "discounted_cash": 5150.26, "minimum": 5409.94, "maximum": 8888.74, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5409.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7729.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7729.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5409.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6569.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8888.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8240.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8240.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8240.42, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amputation follow-up surgery", "code_information": [ { "code": "25929", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21491.29, "discounted_cash": 10745.65, "minimum": 1866.77, "maximum": 6595.07, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7881.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10663.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8240.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8240.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8240.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" } ] } ] }, { "description": "26010 drainage finger abscess simple techfee", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 309.00, "discounted_cash": 154.50, "minimum": 202.78, "maximum": 1032.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 762.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1032.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", 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{ "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, 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schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" } ] } ] }, { "description": "Explore/treat finger joint", "code_information": [ { "code": "26080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7913.68, "discounted_cash": 3956.84, "minimum": 1633.26, "maximum": 6044.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3678.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5256.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5256.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3678.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", 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"standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6941.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6941.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" } ] } ] }, { "description": "26600 clsd tx metacarp fx ed charge", "code_information": [ { "code": "26600", "type": "CPT" } ], 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"standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, 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"Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "26605 - clsd tx mc fx single; w/ manip ea bone-hosp", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 478.00, "discounted_cash": 239.00, "minimum": 244.80, "maximum": 2010.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1485.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2010.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 478.00, 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"fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 382.40, "methodology": "percent of total billed charges" }, { "payer_name": 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"payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 11641.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 9895.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 13388.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5518.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5518.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" } ] } ] }, { "description": "26641 cltx carpo/metacarpal dislocation thumb w/manj techfee", "code_information": [ { "code": "26641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, 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"fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total 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244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", 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1110.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1503.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Treat knuckle dislocation", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 240.00, "minimum": 244.80, "maximum": 1503.18, 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"plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", 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"standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", 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249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 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"plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Treat knee dislocation", "code_information": [ { "code": "27550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 478.00, "discounted_cash": 239.00, "minimum": 244.80, "maximum": 2010.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1485.77, "methodology": "fee 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"29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 416.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": 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"Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 416.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 416.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "27562 closed tx patellar dislocation w/anesthesia techfee", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 537.00, "discounted_cash": 268.50, "minimum": 244.80, "maximum": 3752.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2283.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3262.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3262.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2283.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2773.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3752.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 429.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 429.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 429.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Treat kneecap dislocation", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 537.00, "discounted_cash": 268.50, "minimum": 244.80, "maximum": 3752.40, "setting": "both", "payers_information": [ { 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249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 429.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 429.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 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schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13005.63, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 13005.63, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" } ] } ] }, { "description": "Explore/treat ankle joint", 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schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United 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schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4628.45, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4628.45, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "Exc leg/ankle tum deep <5 cm", 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}, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17353.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17353.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 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Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" } ] } ] }, { "description": "27830 closed treatment of proximal tibiofibular joint dislocation; without anesthesia", "code_information": [ { "code": "27830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 555.00, "discounted_cash": 277.50, "minimum": 244.80, "maximum": 2010.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 444.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 444.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 444.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { 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2010.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 444.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 444.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 444.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Treat lower leg dislocation", "code_information": [ { "code": "27832", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48490.47, "discounted_cash": 24245.24, "minimum": 7290.35, "maximum": 13388.40, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 11641.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 11641.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 9895.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 13388.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 7436.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 7436.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 38792.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 38792.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 38792.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" } ] } ] }, { "description": "27840 closed tx ankle dislocation w/o anesthesia techfee", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 412.00, "discounted_cash": 206.00, "minimum": 244.80, "maximum": 2010.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1485.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2010.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 329.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 329.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 329.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "Treat ankle dislocation", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 412.00, "discounted_cash": 206.00, "minimum": 244.80, "maximum": 2010.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1748.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1223.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1485.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2010.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 329.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 329.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 329.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "27842 cltx ankle dislc req anes w/wo prq skel fixj techfee", "code_information": [ { "code": "27842", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 1125.00, "minimum": 1633.26, "maximum": 3752.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2283.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3262.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3262.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2283.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2773.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3752.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1665.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1665.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1633.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 34176.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 34176.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2920.79, "methodology": "fee schedule" } ] } ] }, { "description": "Exc foot/toe tum sc < 1.5 cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 42720.07, "discounted_cash": 21360.04, 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"standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 732.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 718.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1371.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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244.80, "methodology": "fee schedule" } ] } ] }, { "description": "28630 cltx metatarsophlngl jt dislc w/o anes techfee", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 500.00, "discounted_cash": 250.00, "minimum": 244.80, "maximum": 1503.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 914.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1307.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1307.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 914.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1110.98, "methodology": "fee schedule" }, { "payer_name": 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"standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", 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244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 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"methodology": "fee schedule" } ] } ] }, { "description": "Amputation of midfoot", "code_information": [ { "code": "28800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53954.20, "discounted_cash": 26977.10, "minimum": 6633.16, "maximum": 10898.53, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 6633.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 9476.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 9476.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6633.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8054.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", 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"29030860", "standard_charge_dollar": 6633.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 9476.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 9476.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6633.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8054.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10898.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 43163.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 43163.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 43163.36, "methodology": "percent 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"standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 35208.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 35208.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" } ] 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"payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20473.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20473.64, "methodology": "percent of 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"standard_charge_dollar": 7912.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3377.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3311.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3311.20, "methodology": "fee 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"payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total 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Lincs", "plan_name": "29030808", "standard_charge_dollar": 914.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1110.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1503.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 249.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 244.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 244.80, "methodology": "fee schedule" } ] } ] }, { "description": "29105 application long arm splint shoulder hand techfee", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 310.00, "discounted_cash": 155.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 248.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 248.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 248.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "Apply long arm splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 310.00, "discounted_cash": 155.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 248.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 248.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 248.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "29125 application short arm splint forearm-hand static techfee", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10025.43, "discounted_cash": 5012.72, "minimum": 131.55, "maximum": 874.98, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "29125 application short arm splint forearm-hand static techfee", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "minimum": 131.55, "maximum": 874.98, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Apply forearm splint", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10025.43, "discounted_cash": 5012.72, "minimum": 131.55, "maximum": 874.98, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8020.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Apply forearm splint", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "minimum": 131.55, "maximum": 874.98, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "29126 application short arm splint dynamic", "code_information": [ { "code": "29126", "type": "CPT" } ], 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Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "29130 apl fng splnt static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 128.00, "discounted_cash": 64.00, "minimum": 131.55, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl 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schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", 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"Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "29131 application finger splint dynamic techfee", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 137.00, "discounted_cash": 68.50, "minimum": 60.62, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Application of finger splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 137.00, "discounted_cash": 68.50, "minimum": 60.62, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "29445 application of rigid total contact leg cast tech fee", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 575.00, "discounted_cash": 287.50, "minimum": 271.03, "maximum": 464.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 282.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 404.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 404.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 282.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 343.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 464.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 276.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 276.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 460.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 460.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 460.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 271.03, "methodology": "fee schedule" } ] } ] }, { "description": "Apply rigid leg cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 575.00, "discounted_cash": 287.50, "minimum": 271.03, "maximum": 464.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 282.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 404.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 404.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 282.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 343.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 464.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 276.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 276.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 460.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 460.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 460.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 271.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 271.03, "methodology": "fee schedule" } ] } ] }, { "description": "29505 appl long leg splint ed charge", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 335.00, "discounted_cash": 167.50, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 268.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 268.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 268.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "Application long leg splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 335.00, "discounted_cash": 167.50, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 268.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 268.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 268.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "29515 appl splint short leg", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "Application lower leg splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "29580 application of bilateral unna boot", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "Application of paste boot", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "29581 applcation of mult-layer compression system below knee tech fee", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "Apply multlay comprs lwr leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 161.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 646.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 874.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.03, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.03, "methodology": "fee schedule" } ] } ] }, { "description": "29700 cast removal(orginal put on another clinic charge", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 575.00, "discounted_cash": 287.50, "minimum": 271.03, "maximum": 874.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 532.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 760.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", 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"standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7181.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7181.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "Resect inferior turbinate", "code_information": [ { "code": "30140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8976.37, "discounted_cash": 4488.19, "minimum": 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"fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7181.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7181.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "30300 removal foreign body intranasal office procedure techfee", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 130.00, "minimum": 126.87, "maximum": 134.18, "setting": "both", "payers_information": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, 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"payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 236.99, "methodology": "fee schedule" } ] } ] }, { "description": "Change of windpipe airway", "code_information": [ { 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Medicare", "plan_name": "29046303", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, 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Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 202.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 202.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 198.12, "methodology": "fee schedule" } ] } ] }, { "description": "Diagnostic laryngoscopy", "code_information": [ { "code": "31505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 470.00, "discounted_cash": 235.00, "minimum": 126.87, "maximum": 202.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 198.12, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 198.12, "methodology": "fee schedule" } ] } ] }, { "description": "Laryngoscopy w/bx & op scope", "code_information": [ { "code": "31536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6501.35, 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"payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9510.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of artery clot", "code_information": [ { "code": "34101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27208.43, "discounted_cash": 13604.22, "minimum": 2115.61, "maximum": 5626.98, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2115.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3022.56, "methodology": 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}, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 671.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Place catheter in artery", "code_information": [ { "code": "36217", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 839.00, "discounted_cash": 419.50, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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{ "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5043.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5043.20, "methodology": "percent of 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Advantage", "plan_name": "29739437", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 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Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5626.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5626.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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"standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" } ] } ] }, { "description": "36227 place cath xtrnl carotid", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 283.00, "discounted_cash": 141.50, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Place cath xtrnl carotid", "code_information": [ { "code": "36227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 283.00, "discounted_cash": 141.50, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "36245 selective catheter placement arterial system; each first order abdominal pelvic or lower ex", "code_information": [ { "code": "36245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 630.00, "discounted_cash": 315.00, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": 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"plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 504.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": 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Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 561.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 561.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 561.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ins cath abd/l-ext art 2nd", "code_information": [ { "code": "36246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 702.00, "discounted_cash": 351.00, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 561.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 561.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 561.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ins cath abd/l-ext art 3rd", "code_information": [ { "code": "36247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18288.38, "discounted_cash": 9144.19, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 14630.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 14630.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 14630.70, "methodology": "percent of total billed charges" } ] } ] }, { "description": "36248 xa renal&below add selective 2nd or 3rd", "code_information": [ { "code": "36248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 67.50, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ins cath abd/l-ext art addl", "code_information": [ { "code": "36248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 67.50, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "36251 xa abd aortogram sel renal angio", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 3212.10, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Ins cath ren art 1st unilat", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 3212.10, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Ins cath ren art 1st bilat", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13449.93, "discounted_cash": 6724.97, "minimum": 3212.10, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10759.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10759.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10759.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "36410 venipuncture fem/jugular charge", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 52.00, "discounted_cash": 26.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Non-routine bl draw 3/> yrs", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 52.00, "discounted_cash": 26.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "36415 blood collection; venipuncture.", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 11.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 17.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Routine venipuncture", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 11.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 17.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Capillary blood draw", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 5.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Heel/finger stick pku", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 5.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "36430 blood infusion per day", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15771.68, "discounted_cash": 7885.84, "minimum": 446.15, "maximum": 3239.91, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12617.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12617.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12617.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 446.15, "methodology": "fee schedule" } ] } ] }, { "description": "36430 blood infusion per day", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 920.00, "discounted_cash": 460.00, "minimum": 446.15, "maximum": 3239.91, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 736.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 736.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 736.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 446.15, "methodology": "fee schedule" } ] } ] }, { "description": "Blood transfusion service", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15771.68, "discounted_cash": 7885.84, "minimum": 446.15, "maximum": 3239.91, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12617.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12617.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12617.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 446.15, "methodology": "fee schedule" } ] } ] }, { "description": "Blood transfusion service", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 920.00, "discounted_cash": 460.00, "minimum": 446.15, "maximum": 3239.91, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 455.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 736.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 736.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 736.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 446.15, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 446.15, "methodology": "fee schedule" } ] } ] }, { "description": "Bl push transfuse 2 yr/<", "code_information": [ { "code": "36440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15411.39, "discounted_cash": 7705.70, 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407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 690.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", 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3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4317.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1182.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1182.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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{ "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 643.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 643.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, 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"plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4216.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4216.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4216.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Insj picc rs&i 5 yr+", "code_information": [ { "code": "36573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3291.78, "discounted_cash": 1645.89, "minimum": 1585.32, "maximum": 1617.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2633.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2633.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2633.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Repair tunneled cv cath", "code_information": [ { "code": "36575", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 900.00, "discounted_cash": 450.00, "minimum": 580.03, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 643.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 643.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 630.95, "methodology": "fee 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}, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 720.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 720.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 630.95, "methodology": "fee schedule" } ] } ] }, { "description": "36576 prof repair cva dev w prt/pm", "code_information": [ { "code": "36576", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1500.00, "discounted_cash": 750.00, "minimum": 1541.74, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Repair tunneled cv cath", "code_information": [ { "code": "36576", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1500.00, "discounted_cash": 750.00, "minimum": 1541.74, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "36580 hd cath temp replaced", "code_information": [ { "code": "36580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1875.00, "discounted_cash": 937.50, "minimum": 1541.74, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Replace cvad cath", "code_information": [ { "code": "36580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1875.00, "discounted_cash": 937.50, "minimum": 1541.74, "maximum": 2533.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2202.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1541.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1872.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2533.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", 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"standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Replace tunneled cv cath", "code_information": [ { "code": "36581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5939.00, "discounted_cash": 2969.50, "minimum": 3212.10, "maximum": 7575.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5598.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7575.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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"payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Replace tunneled cv cath", "code_information": [ { "code": "36582", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9854.45, "discounted_cash": 4927.23, "minimum": 3212.10, "maximum": 7575.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": 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"standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1028.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1028.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Removal tunneled cv cath", "code_information": [ { "code": "36589", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4161.13, "discounted_cash": 2080.57, "minimum": 276.50, "maximum": 643.57, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 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"plan_name": "29042596", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 215.01, "methodology": "fee schedule" } ] } ] }, { "description": "Inj w/fluor eval cv device", "code_information": [ { "code": "36598", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.00, "discounted_cash": 187.50, "minimum": 126.87, "maximum": 219.31, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 300.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": 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"standard_charges": [ { "gross_charge": 8516.74, "discounted_cash": 4258.37, "minimum": 131.55, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", 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charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Insertion catheter artery", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 4186.60, "maximum": 4186.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4186.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Arterial line insertion", "code_information": [ { "code": "36660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 536.00, "discounted_cash": 268.00, "minimum": 4610.69, "maximum": 7575.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5598.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7575.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Insertion catheter artery", "code_information": [ { "code": "36660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 536.00, "discounted_cash": 268.00, "minimum": 4610.69, "maximum": 7575.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6587.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4610.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5598.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7575.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "36680 placement needle intraosseous infusion techfee", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.00, "discounted_cash": 312.50, "minimum": 407.23, "maximum": 415.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.23, "methodology": "fee schedule" } ] } ] }, { "description": "Insert needle bone cavity", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.00, "discounted_cash": 312.50, "minimum": 407.23, "maximum": 415.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.23, "methodology": "fee schedule" } ] } ] }, { "description": "Open thrombect av fistula", "code_information": [ { "code": "36831", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27208.43, "discounted_cash": 13604.22, "minimum": 5516.65, "maximum": 12487.47, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 7600.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10858.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10858.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7600.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 9229.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "37211 xa thrombolysis other", "code_information": [ { "code": "37211", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96191.42, "discounted_cash": 48095.71, "minimum": 5516.65, "maximum": 22795.72, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 13874.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 19821.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 19821.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 13874.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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}, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 37251.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 37251.50, "methodology": "percent 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} ] }, { "description": "37785 ligj divj &/excj varicose vein cluster 1 leg techfee", "code_information": [ { "code": "37785", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6890.00, "discounted_cash": 3445.00, "minimum": 3212.10, "maximum": 8391.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5107.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7296.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7296.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5107.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6202.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Ligate/divide/excise vein", "code_information": [ { "code": "37785", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6890.00, "discounted_cash": 3445.00, "minimum": 3212.10, "maximum": 8391.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5107.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7296.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7296.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5107.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6202.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8391.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5512.00, 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"standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 31566.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 31566.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 630.95, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 630.95, "methodology": "fee schedule" } ] } ] }, { "description": "38220 bone marrow aspiration only", "code_information": [ { "code": "38220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3213.00, "discounted_cash": 1606.50, "minimum": 1205.92, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1653.49, "methodology": "fee 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"29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2570.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2570.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2570.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" } ] } ] }, { "description": "38221 - cath lab bone marrow biopsy", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3255.00, "discounted_cash": 1627.50, "minimum": 1205.92, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1686.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1653.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", 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Medicare", "plan_name": "30770134", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1450.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1450.40, "methodology": "percent of total billed charges" }, { 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"29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 762.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1032.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 530.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 530.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4852.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4852.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4852.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 519.70, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 519.70, "methodology": "fee schedule" } ] } ] }, { "description": "Excision of mouth lesion", "code_information": [ { 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Medicare", "plan_name": "29046303", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4595.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4595.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4595.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "Excise lip or cheek fold", "code_information": [ { "code": "40819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5335.15, "discounted_cash": 2667.58, "minimum": 1511.68, "maximum": 7099.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4321.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6173.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6173.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4321.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5247.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7099.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1541.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1541.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4268.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": 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Administration", "plan_name": "29042596", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" } ] } ] }, { "description": "Incision of tongue fold", "code_information": [ { "code": "41010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5721.72, "discounted_cash": 2860.86, "minimum": 1511.68, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", 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"28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4135.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4135.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4135.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "Excision of tongue fold", "code_information": [ { "code": "41115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5162.60, "discounted_cash": 2581.30, "minimum": 1511.68, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1541.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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Administration", "plan_name": "29042596", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" } ] } ] }, { "description": "Tongue and neck surgery", "code_information": [ { "code": "41135", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38608.83, "discounted_cash": 19304.42, "minimum": 9660.53, "maximum": 15872.63, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 9660.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 13801.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 13801.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 9660.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 11731.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 15872.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Removal of tongue", "code_information": [ { "code": "41140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38608.83, "discounted_cash": 19304.42, "minimum": 9660.53, "maximum": 15872.63, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 9660.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 13801.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 13801.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 9660.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 11731.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 15872.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tongue jaw & neck surgery", "code_information": [ { "code": "41155", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38608.83, "discounted_cash": 19304.42, "minimum": 9660.53, "maximum": 15872.63, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 9660.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 13801.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 13801.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 9660.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 11731.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 15872.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" } ] } ] }, { "description": "41250 rpr lac 2.5 cm/< mouth&/ant two-thirds tong techfee", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 625.00, "discounted_cash": 312.50, "minimum": 407.23, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.23, "methodology": "fee schedule" } ] } ] }, { "description": "Repair tongue laceration", "code_information": [ { "code": "41250", "type": "CPT" } ], "standard_charges": [ { 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407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.23, "methodology": "fee schedule" } ] } ] }, { "description": "41252 rpr lac tongue floor mouth > 2.6 cm/cplx techfee", "code_information": [ { "code": "41252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 500.00, "discounted_cash": 250.00, "minimum": 236.99, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 236.99, "methodology": "fee schedule" } ] } ] }, { "description": "Repair tongue laceration", "code_information": [ { "code": "41252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 500.00, "discounted_cash": 250.00, "minimum": 236.99, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 400.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 236.99, "methodology": "fee schedule" } ] } ] }, { "description": "Hep a vac injxn admin/recvd", "code_information": [ { "code": "4148F", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3380.90, "discounted_cash": 1690.45, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2704.72, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2704.72, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2704.72, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hep b vac injxn admin/recvd", "code_information": [ { "code": "4149F", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3380.90, "discounted_cash": 1690.45, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2704.72, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2704.72, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2704.72, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt care icu&vent w/in 24hrs", "code_information": [ { "code": "4168F", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25720.95, "discounted_cash": 12860.48, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 20576.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20576.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20576.76, "methodology": "percent of total billed charges" } ] } ] }, { "description": "No pt care icu/vent in 24hrs", "code_information": [ { "code": "4169F", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 86644.90, "discounted_cash": 43322.45, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 69315.92, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 69315.92, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 69315.92, "methodology": "percent of total billed charges" } ] } ] }, { "description": "41800 drg absc cst hmtma from dentoalveolar struxs techfee", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 131.55, "maximum": 1032.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 762.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1032.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Drainage of gum lesion", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 338.00, "discounted_cash": 169.00, "minimum": 131.55, "maximum": 1032.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 897.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 628.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 762.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1032.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 270.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Approp diuretic tstng done", "code_information": [ { "code": "4190F", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19529.02, "discounted_cash": 9764.51, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 15623.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 15623.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 15623.22, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt rcvng anti-rheum thxpy ra", "code_information": [ { "code": "4195F", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38097.93, "discounted_cash": 19048.97, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 30478.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 30478.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 30478.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Biopsy roof of mouth", "code_information": [ { "code": "42100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6120.50, "discounted_cash": 3060.25, "minimum": 1511.68, "maximum": 3216.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1541.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1541.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4896.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1511.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 241.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 236.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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{ "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8026.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8026.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8026.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "Excise pharynx lesion", "code_information": [ { "code": "42808", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8651.34, "discounted_cash": 4325.67, "minimum": 3309.63, "maximum": 5753.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5002.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3501.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4252.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5753.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6921.07, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6921.07, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6921.07, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "Remove tonsils and adenoids", 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schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6157.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6157.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United 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3375.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4583.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", 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"standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 14071.79, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 14071.79, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" } ] } ] }, { "description": "Esophagosc dilate balloon 30", "code_information": [ { "code": "43214", "type": "CPT" } ], 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}, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9865.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9865.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1935.92, 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schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 21293.61, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1935.92, "methodology": 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"standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" } ] } ] }, { "description": "Esophagoscop ultrasound exam", "code_information": [ { "code": "43231", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21768.55, "discounted_cash": 10884.28, "minimum": 1267.95, "maximum": 1974.64, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1974.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1974.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 17414.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17414.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17414.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" } ] } ] }, { "description": "Esophagoscopy w/us needle bx", "code_information": [ { "code": "43232", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35322.29, "discounted_cash": 17661.15, "minimum": 1267.95, "maximum": 1974.64, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1267.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1974.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1974.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1935.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", 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407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9353.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": 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billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.23, "methodology": "fee schedule" } ] } ] }, { "description": "Gastric lavage administer", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11691.36, "discounted_cash": 5845.68, "minimum": 317.79, "maximum": 415.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9353.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9353.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Gastric lavage administer", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Tx gastro intub w/asp", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11691.36, "discounted_cash": 5845.68, "minimum": 317.79, "maximum": 415.14, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9353.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9353.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9353.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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{ "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Dx gastr intub w/asp specs", "code_information": [ { "code": "43755", "type": "CPT" } ], "standard_charges": [ { 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159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9353.09, 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126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": 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"29043841", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 248.20, "methodology": "fee schedule" } ] } ] }, { "description": "Reposition gastrostomy tube", "code_information": [ { "code": "43761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 554.00, "discounted_cash": 277.00, "minimum": 126.87, "maximum": 253.17, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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"Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 248.20, "methodology": "fee schedule" } ] } ] }, { "description": "Rplc gtube no revj trc", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2.60, "discounted_cash": 1.30, "minimum": 248.20, "maximum": 629.92, 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"29030748", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 492.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 248.20, "methodology": "fee schedule" } ] } ] }, { "description": "Rplc gtube revj gstrst trc", "code_information": [ { "code": "43763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 615.00, "discounted_cash": 307.50, "minimum": 248.20, "maximum": 629.92, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 492.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 248.20, "methodology": 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schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 10837.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13375.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13375.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, 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"standard_charge_dollar": 11373.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7960.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 9667.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 13079.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13375.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13375.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 13375.51, "methodology": 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Traditional", "plan_name": "29030835", "standard_charge_dollar": 13079.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3882.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3960.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3960.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3882.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3882.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3882.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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Medicare", "plan_name": "36347772", "standard_charge_dollar": 930.42, "methodology": "fee schedule" } ] } ] }, { "description": "Diagnostic sigmoidoscopy", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3436.28, "discounted_cash": 1718.14, "minimum": 930.42, "maximum": 3032.74, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1845.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2637.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2637.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1845.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2241.46, 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"payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2750.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1227.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3174.79, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3174.79, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, 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"plan_name": "30770242", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 29051.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 29051.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 930.42, "methodology": "fee schedule" } ] } ] }, { "description": "Repair rectum/remove sigmoid", "code_information": [ { "code": "45550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36131.25, "discounted_cash": 18065.63, "minimum": 4664.69, "maximum": 7664.27, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5664.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", 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"payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2854.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent 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fistula w/colostomy", "code_information": [ { "code": "45825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 36217.56, "discounted_cash": 18108.78, "minimum": 4664.69, "maximum": 7664.27, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5664.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7664.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 28974.05, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28974.05, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28974.05, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Remove rectal obstruction", "code_information": [ { "code": "45915", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7582.72, "discounted_cash": 3791.36, "minimum": 1203.28, "maximum": 6250.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3804.35, "methodology": "fee 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"payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4609.73, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4609.73, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4609.73, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 930.42, "methodology": "fee schedule" } ] } ] }, { "description": "46083 inc of thrombosed hemorr ed charge", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 502.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 502.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 502.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 930.42, "methodology": "fee schedule" } ] } ] }, { "description": "Ligation of hemorrhoid(s)", "code_information": [ { "code": "46221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1875.00, "discounted_cash": 937.50, "minimum": 930.42, "maximum": 3216.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2797.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1957.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2377.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3216.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1500.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 930.42, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of anal tags", "code_information": [ { "code": "46230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4865.18, "discounted_cash": 2432.59, "minimum": 2798.67, "maximum": 6250.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3804.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5435.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5435.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3804.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4619.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6250.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2854.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2854.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3892.14, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3892.14, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3892.14, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" } ] } ] }, { "description": "Remove ext hem groups 2+", "code_information": [ { "code": "46250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5536.47, "discounted_cash": 2768.24, "minimum": 2798.67, "maximum": 7664.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5664.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7664.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2854.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2854.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4429.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4429.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4429.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2798.67, "methodology": "fee schedule" } ] } ] }, { "description": "Removal of hemorrhoid clot", "code_information": [ { "code": "46320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6883.76, "discounted_cash": 3441.88, "minimum": 1203.28, "maximum": 6250.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3804.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5435.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5435.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3804.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4619.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6250.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1227.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1227.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5507.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5507.01, "methodology": "percent of 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{ "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1203.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2080.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2080.80, "methodology": "percent of 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anoper fistu", "code_information": [ { "code": "46715", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11912.08, "discounted_cash": 5956.04, "minimum": 4664.69, "maximum": 7664.27, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6664.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4664.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5664.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7664.27, 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schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5890.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5890.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" } ] } ] }, { "description": "Plmt biliary drainage cath", 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{ "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", 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}, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5312.25, "methodology": "percent of total billed 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"standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 18518.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": 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"plan_name": "29030748", "standard_charge_dollar": 9137.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6395.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7766.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10508.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3601.49, "methodology": "fee 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"standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5428.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5428.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr fem hernia init blocked", "code_information": [ { "code": "49553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6785.67, "discounted_cash": 3392.84, "minimum": 3601.49, "maximum": 3673.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3601.49, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": 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Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5428.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5428.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr aa hrn 1st < 3 cm rdc", "code_information": [ { "code": "49591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9109.54, "discounted_cash": 4554.77, "minimum": 3601.49, "maximum": 3673.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7287.63, 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total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7287.63, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr aa hrn 1st < 3 ncr/strn", "code_information": [ { "code": "49592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10817.34, "discounted_cash": 5408.67, "minimum": 5954.10, "maximum": 6073.19, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8653.87, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8653.87, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8653.87, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr aa hrn 1st 3-10 ncr/strn", "code_information": [ { "code": "49594", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10162.10, "discounted_cash": 5081.05, "minimum": 5954.10, "maximum": 6073.19, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8129.68, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8129.68, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8129.68, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" } ] } ] }, { "description": "Repair umbilical lesion", "code_information": [ { "code": "49605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19723.15, "discounted_cash": 9861.58, "minimum": 6063.59, "maximum": 9962.70, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 6063.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8663.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8663.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6063.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7363.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9962.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 15778.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 15778.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 15778.52, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Repair umbilical lesion", "code_information": [ { "code": "49606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19723.15, "discounted_cash": 9861.58, "minimum": 6395.95, "maximum": 10508.79, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 6395.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 9137.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 9137.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 6395.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7766.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10508.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 15778.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 15778.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 15778.52, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rpr aa hrn rcr < 3 rdc", "code_information": [ { "code": "49613", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11996.16, "discounted_cash": 5998.08, "minimum": 3601.49, "maximum": 3673.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3673.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9596.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9596.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9596.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3601.49, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr aa hrn rcr < 3 ncr/strn", "code_information": [ { "code": "49614", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12674.72, "discounted_cash": 6337.36, "minimum": 5954.10, "maximum": 6073.19, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6073.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10139.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" 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of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5954.10, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr aa hrn rcr 3-10 ncr/strn", "code_information": [ { "code": "49616", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10327.05, "discounted_cash": 5163.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8261.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8261.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10324.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10324.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10324.10, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rmvl ninfct mesh hernia rpr", "code_information": [ { "code": "49623", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13811.29, "discounted_cash": 6905.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11049.03, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 942.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 942.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 942.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 681.17, "methodology": "fee schedule" } ] } ] }, { "description": "50432 placement 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"methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2090.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2132.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2132.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2090.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2090.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2090.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2090.55, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"standard_charge_dollar": 1059.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1059.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 360.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": 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"Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 259.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "51705 change cystostomy tube simple techfee", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 428.00, "discounted_cash": 214.00, "minimum": 248.20, "maximum": 629.92, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 629.92, "methodology": "fee 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"standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 248.20, "methodology": "fee schedule" } ] } ] }, { "description": "Change of bladder tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 428.00, "discounted_cash": 214.00, "minimum": 248.20, "maximum": 629.92, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 629.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 253.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": 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"payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3815.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5451.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5451.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3815.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4633.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6268.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 694.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 694.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 681.17, "methodology": "fee schedule" } ] } ] }, { "description": "Treatment of bladder lesion", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 428.00, "discounted_cash": 214.00, "minimum": 681.17, "maximum": 6268.95, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 3815.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5451.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5451.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 3815.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4633.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6268.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 694.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 694.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 342.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 681.17, "methodology": "fee schedule" } ] } ] }, { "description": "Cmpx cystometrogram", "code_information": [ { "code": "51728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1339.00, "discounted_cash": 669.50, "minimum": 681.17, "maximum": 1754.88, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1068.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1525.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1525.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1068.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1297.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1754.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 694.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 694.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 681.17, "methodology": "fee schedule" } ] } ] }, { "description": "Cystometrogram w/vp", "code_information": [ { "code": "51728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1339.00, "discounted_cash": 669.50, "minimum": 681.17, "maximum": 1754.88, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 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}, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 259.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Emg of anal/urethral", "code_information": [ { "code": "51784", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.00, "discounted_cash": 162.00, "minimum": 159.67, "maximum": 181.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 259.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 259.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 259.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "51792 simulus evoked response", "code_information": [ { "code": "51792", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 67.00, "minimum": 60.62, "maximum": 126.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Urinary reflex study", "code_information": [ { "code": "51792", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 67.00, "minimum": 60.62, "maximum": 126.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "51797 complex cystometrogram; with voiding pressure studies and urethral pressure profile studies", "code_information": [ { "code": "51797", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 299.00, "discounted_cash": 149.50, "minimum": 1068.07, "maximum": 1754.88, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1068.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1525.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1525.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1068.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1297.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1754.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Intraabdominal pressure test", "code_information": [ { "code": "51797", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 299.00, "discounted_cash": 149.50, "minimum": 1068.07, "maximum": 1754.88, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1068.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1525.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1525.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1068.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1297.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1754.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Meas post-voiding residual urine&/bladder cap techfee", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 59.00, "minimum": 60.62, "maximum": 126.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 94.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 94.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 94.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Us urine capacity measure", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 59.00, "minimum": 60.62, "maximum": 126.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 94.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 94.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 94.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Repair bladder/vagina lesion", "code_information": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 33071.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 33071.18, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 248.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 248.20, "methodology": "fee schedule" } ] } ] }, { "description": "54055 destruction; penis lesion(s)", "code_information": [ { "code": "54055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3690.00, 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"29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2952.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2952.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": 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] }, { "description": "Removal of sperm duct(s)", "code_information": [ { "code": "55250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5652.48, "discounted_cash": 2826.24, "minimum": 2090.55, "maximum": 7313.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4450.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6359.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6359.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4450.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5404.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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1396.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1396.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1396.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1396.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1396.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": 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}, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 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"standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" } ] } ] }, { "description": "57288 sling operation for stress incontinence (eg fascia or synthetic)", "code_information": [ { "code": 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"payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10941.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10941.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7658.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 9299.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12582.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5138.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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Administration", "plan_name": "29042596", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" } ] } ] }, { "description": "Repair bladder & vagina", "code_information": [ { "code": "57289", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16192.88, "discounted_cash": 8096.44, "minimum": 7546.58, "maximum": 12582.88, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 7658.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10941.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10941.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7658.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 9299.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12582.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 7546.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 7697.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 7697.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 7546.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 7546.58, "methodology": "fee schedule" }, { 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}, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11333.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11333.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" } ] } ] }, { "description": "57452 colposcopy (vaginoscopy); (separate procedure)", "code_information": [ { "code": "57452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 268.00, "discounted_cash": 134.00, "minimum": 205.30, "maximum": 1563.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 951.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1359.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1359.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 951.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1155.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1563.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 205.30, "methodology": "fee schedule" } ] } ] }, { "description": "Exam of cervix w/scope", "code_information": [ { "code": "57452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 268.00, "discounted_cash": 134.00, "minimum": 205.30, "maximum": 1563.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 951.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1359.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1359.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 951.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1155.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1563.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 205.30, "methodology": "fee schedule" } ] } ] }, { "description": "Biopsy of cervix", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14228.76, "discounted_cash": 7114.38, "minimum": 888.61, "maximum": 1981.36, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1722.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1205.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1464.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1981.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 906.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 906.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11383.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11383.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11383.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 888.61, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 888.61, "methodology": "fee schedule" } ] } ] }, { "description": "Conization of cervix", "code_information": [ { "code": "57520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9554.88, "discounted_cash": 4777.44, "minimum": 3244.79, "maximum": 6591.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4871.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6591.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7643.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7643.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7643.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" } ] } ] }, { "description": "Conization of cervix", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9052.25, "discounted_cash": 4526.13, "minimum": 3244.79, "maximum": 6591.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4871.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6591.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7241.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7241.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7241.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" } ] } ] }, { "description": "Remove cervix/repair pelvis", "code_information": [ { "code": "57545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16395.48, "discounted_cash": 8197.74, "minimum": 7658.30, "maximum": 12582.88, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 7658.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10941.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10941.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7658.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 9299.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12582.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13116.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13116.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, 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schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6507.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6507.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6507.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" } ] } ] }, { "description": "Hysteroscopy lysis", "code_information": [ { "code": "58559", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6108.47, "discounted_cash": 3054.24, "minimum": 5037.76, "maximum": 8944.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5444.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7777.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7777.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5444.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6611.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8944.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5138.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5138.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4886.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4886.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4886.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" } ] } ] }, { "description": "Hysteroscopy remove fb", "code_information": [ { "code": "58562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6920.28, "discounted_cash": 3460.14, "minimum": 3244.79, "maximum": 8944.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5444.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7777.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7777.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5444.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6611.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8944.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5536.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5536.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5536.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" } ] } ] }, { "description": "Hysteroscopy ablation", "code_information": [ { "code": "58563", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8608.84, "discounted_cash": 4304.42, "minimum": 5037.76, "maximum": 8944.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5444.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 7777.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 7777.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5444.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 6611.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8944.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5138.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5138.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6887.07, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6887.07, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6887.07, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5037.76, "methodology": "fee schedule" } ] } ] }, { "description": "Tlh w/t/o 250 g or less", "code_information": [ { "code": "58571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21735.73, "discounted_cash": 10867.87, "minimum": 8888.86, "maximum": 14604.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8888.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12699.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12699.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8888.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 10794.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 14604.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 10837.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 10837.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 17388.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17388.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17388.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 10624.90, "methodology": "fee schedule" } ] } ] }, { "description": "58600 ligation or transection of fallopian tube(s) abdominal or vaginal approach unilateral or bil", "code_information": [ { "code": "58600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 500.00, "discounted_cash": 250.00, "minimum": 3244.79, "maximum": 9542.88, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 5808.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8297.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8297.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5808.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 7053.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 9542.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12958.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee 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"plan_name": "29030860", "standard_charge_dollar": 246.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 352.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 352.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 246.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 299.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 405.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total 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Lincs", "plan_name": "29030808", "standard_charge_dollar": 246.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 299.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 405.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 205.30, "methodology": 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schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12958.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12958.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 205.30, "methodology": "fee schedule" } ] } ] }, { "description": "Fetal contract stress test", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 352.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 352.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 246.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 299.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 405.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12958.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12958.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12958.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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}, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 299.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 405.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 205.30, "methodology": "fee schedule" } ] } ] }, { "description": "Fetal nonstress test", "code_information": [ { "code": "59025", "type": "CPT" } ], "standard_charges": [ { 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"standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 205.30, "methodology": "fee schedule" }, { "payer_name": "United Health 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 405.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Intrauterine pressure catheter - uterine contraction monitoring method", "code_information": [ { "code": "59050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 42.50, "minimum": 246.92, "maximum": 405.71, 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schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 316.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9712.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9712.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9712.38, "methodology": 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"payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 246.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 299.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 405.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 316.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 316.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", 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"standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 310.43, "methodology": "fee schedule" } ] } ] }, { 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"30770134", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 310.43, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 310.43, "methodology": "fee schedule" } ] } ] }, { "description": "59300 episiotomyvaginal repair by other than attending physician", "code_information": [ { "code": "59300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16192.88, "discounted_cash": 8096.44, "minimum": 3244.79, "maximum": 6591.37, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4622.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { 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"29030860", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4871.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6591.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12954.30, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" } ] } ] }, { "description": "Episiotomy or vaginal repair", "code_information": [ { "code": "59300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5778.00, "discounted_cash": 2889.00, "minimum": 3244.79, "maximum": 6591.37, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4011.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5731.48, "methodology": "fee schedule" }, { 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11447.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11447.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" } ] } ] }, { "description": "Obstetrical care", "code_information": [ { "code": "59410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14309.85, "discounted_cash": 7154.93, "minimum": 2844.00, "maximum": 4672.80, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2844.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 4063.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 4063.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2844.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 3453.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 4672.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11447.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11447.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11447.88, "methodology": "percent of total billed charges" } ] } ] }, { "description": "59412 ext cephalic version", "code_information": [ { "code": "59412", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6198.00, "discounted_cash": 3099.00, "minimum": 3244.79, "maximum": 3309.68, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4958.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4958.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4958.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" } ] } ] }, { "description": "Antepartum manipulation", "code_information": [ { "code": "59412", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6198.00, "discounted_cash": 3099.00, "minimum": 3244.79, "maximum": 3309.68, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3309.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", 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Tricare", "plan_name": "29043841", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3244.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4958.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4958.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3244.79, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19205.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19205.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 6037.07, "methodology": "fee schedule" } ] } ] }, { "description": "Explore 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"standard_charge_dollar": 926.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 926.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1502.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1502.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1502.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 908.56, "methodology": "fee schedule" } ] } ] }, { "description": "Dx lmbr spi pnxr w/fluor/ct", "code_information": [ { "code": "62328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35823.80, "discounted_cash": 17911.90, "minimum": 706.73, "maximum": 2083.24, "setting": "inpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1267.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1811.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", 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706.73, "methodology": "fee schedule" } ] } ] }, { "description": "Dx lmbr spi pnxr w/fluor/ct", "code_information": [ { "code": "62328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3829.29, "discounted_cash": 1914.65, "minimum": 706.73, "maximum": 2083.24, "setting": "outpatient", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1267.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1811.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1811.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1267.92, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1539.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2083.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 720.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 720.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3063.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 706.73, "methodology": 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schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6666.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 6535.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 6535.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 6535.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 6535.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 42071.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 6535.51, "methodology": 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Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 312.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 19395.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19395.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19395.56, "methodology": "percent of total billed charges" }, { 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"payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19395.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19395.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 306.07, "methodology": "fee schedule" } ] } ] }, { "description": "Anl sp inf pmp w/mdreprg&fil", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 312.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 312.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 306.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 13965.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 13965.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 9774.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 11869.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 16060.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 7290.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 7436.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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"payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2586.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 706.73, "methodology": "fee schedule" } ] } ] }, { "description": "Injection anesthetic agent; pudendal nerve", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1823.00, "discounted_cash": 911.50, "minimum": 908.56, "maximum": 1909.23, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1162.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1660.16, 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"United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 908.56, "methodology": "fee schedule" } ] } ] }, { "description": "Njx aa&/strd pudendal nerve", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1823.00, "discounted_cash": 911.50, "minimum": 908.56, "maximum": 1909.23, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1162.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1660.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1660.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1162.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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80.0, "estimated_amount": 2530.31, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 706.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2530.31, 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}, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2810.24, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 908.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 908.56, "methodology": "fee schedule" } ] } ] }, { "description": "N block lumbar/thoracic", "code_information": [ { "code": "64520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3626.03, "discounted_cash": 1813.02, "minimum": 908.56, "maximum": 3116.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1896.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2709.99, "methodology": "fee 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"65220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 640.00, "discounted_cash": 320.00, "minimum": 126.87, "maximum": 415.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.23, "methodology": "fee schedule" } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 640.00, "discounted_cash": 320.00, "minimum": 126.87, "maximum": 415.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 512.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.23, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.23, "methodology": "fee schedule" } ] } ] }, { "description": "65222 fb removal eye w/slit l ed charge", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 130.00, "minimum": 16.23, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 16.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 16.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 16.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 16.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 16.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 16.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, 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}, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "65235 proc fb reml intraocular ln ed charge", "code_information": [ { "code": "65235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4905.00, "discounted_cash": 2452.50, "minimum": 2327.54, "maximum": 7039.04, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4284.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6120.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6120.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4284.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5202.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7039.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2374.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2374.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3924.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3924.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3924.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4905.00, "discounted_cash": 2452.50, "minimum": 2327.54, "maximum": 7039.04, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4284.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 6120.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 6120.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4284.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5202.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 7039.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2374.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2374.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { 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}, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4356.79, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4356.79, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2327.54, "methodology": "fee schedule" } ] } ] }, { "description": "67700 blepharotomy drainage of abscess ed tech", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 642.00, "discounted_cash": 321.00, "minimum": 305.07, "maximum": 2962.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1803.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2576.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2576.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1803.18, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 513.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 513.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 513.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 305.07, "methodology": "fee schedule" } ] } ] }, { "description": "Drainage of eyelid abscess", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { 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305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 311.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 311.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 513.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 305.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 513.60, "methodology": "percent of total 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"standard_charge_dollar": 2576.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2576.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1803.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2189.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2962.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2428.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2428.46, "methodology": "fee schedule" }, { "payer_name": 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"payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4316.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4316.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" } ] } ] }, { "description": "Incision of eyelid fold", "code_information": [ { "code": "67715", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5396.10, "discounted_cash": 2698.05, "minimum": 1803.18, "maximum": 2962.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1803.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2576.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2576.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1803.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4316.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4316.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4316.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2380.84, "methodology": "fee schedule" } ] } ] }, { "description": "Remove eyelid foreign body", "code_information": [ { "code": "67938", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4111.91, 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Cn", "plan_name": "29030748", "standard_charge_dollar": 13801.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 9660.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 11731.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 15872.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 30887.06, "methodology": "percent of total billed charges" } ] } ] }, { "description": "69200 clear outer canal charge - ed tech", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 415.00, "discounted_cash": 207.50, "minimum": 126.87, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": 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"standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Clear outer ear canal", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 415.00, "discounted_cash": 207.50, "minimum": 126.87, "maximum": 134.18, "setting": "both", "payers_information": [ { 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{ "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4660.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3309.63, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of jaw 4/> views", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 86.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee 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"standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr mandible complete minimum 4 views", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 86.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 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Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of mastoids", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 125.00, "discounted_cash": 62.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", 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"standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 100.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 100.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 100.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr mastoids complete left", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 125.00, "discounted_cash": 62.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of eye sockets", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr orbits complete min 4 views", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of sinuses", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 86.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr sinuses paranasal complete", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 86.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "70250 xr skull < 4 views", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of skull", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "70260 xr skull complete", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 259.00, "discounted_cash": 129.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 207.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 207.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 207.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of skull", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 259.00, "discounted_cash": 129.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 207.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 207.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 207.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of jaw joint", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr tmj open and closed left", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "70328 xr tmj open and closed left", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "70328 xr tmj open and closed right", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "70330 xr tmj open and closed bilateral", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": 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Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad 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} ] } ] }, { "description": "X-ray exam of neck", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 69.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, 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"methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "70450 ct:head w/o contr", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.00, "discounted_cash": 521.50, "minimum": 220.56, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct head/brain w/o dye", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1043.00, "discounted_cash": 521.50, "minimum": 220.56, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United 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"36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct head/brain w/dye", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1123.00, "discounted_cash": 561.50, "minimum": 220.56, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 898.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 898.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "70470 head/brain w/o and w/contrast", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1344.00, "discounted_cash": 672.00, "minimum": 220.56, "maximum": 452.93, "setting": "both", 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"standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1075.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1075.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1075.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct head/brain w/o & w/dye", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1344.00, "discounted_cash": 672.00, "minimum": 220.56, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 220.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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"30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 897.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 897.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "70481--ct orbit/ear/fossa w/contrast", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1183.00, "discounted_cash": 591.50, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", 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"estimated_amount": 946.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 946.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 946.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "70482 computed tomography orbit sella or posterior fossa or outer middle or inner ear.", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1253.00, "discounted_cash": 626.50, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1002.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1002.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1002.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct orbit/ear/fossa w/o&w/dye", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1253.00, "discounted_cash": 626.50, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1002.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1002.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "70486 ct:max-facial w/o", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { 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"payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 897.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": 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"setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1001.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1001.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1001.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct maxillofacial w/o & w/dye", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 626.00, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1001.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1001.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1001.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "70490 ct of soft tissue neck without contrast", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1163.00, "discounted_cash": 581.50, "minimum": 229.16, "maximum": 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Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 930.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 930.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "70491 ct:soft tissue neck w/contrast", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1277.00, "discounted_cash": 638.50, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1021.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee 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"Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1021.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1021.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1021.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "70492 ct:soft tissue neck w&w/o", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1312.00, "discounted_cash": 656.00, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1049.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1049.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1049.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct sft tsue nck w/o & w/dye", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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"type": "CPT" } ], "standard_charges": [ { "gross_charge": 1964.00, "discounted_cash": 982.00, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": 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}, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, 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"standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri orbt/fac/nck w/o &w/dye", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": 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"standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", 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"payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total 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schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri brain stem w/dye", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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"standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri brain w/wo contrast", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { 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872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, 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Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "71046 xr chest 2 view", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "minimum": 59.26, "maximum": 877.10, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, 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"payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam chest 4+ views", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 187.00, "discounted_cash": 93.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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"30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr chest minimum 4 views", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 187.00, "discounted_cash": 93.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam ribs uni 2 views", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr ribs 2 views left", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "71100 xr ribs 2 views left", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "71100 xr ribs 2 views right", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { 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"plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam unilat ribs/chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 108.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr ribs min 3 views left w/ pa chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 108.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "71101 xr min 3 view ribs w/ pa chest left", "code_information": [ { "code": "71101", "type": "CPT" } ], 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Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "71101 xr min 3 view ribs w/ pa chest right", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 108.00, "minimum": 108.52, "maximum": 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Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "71110 xr ribs 3 views bilateral", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { 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"standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": 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Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "71111 xr ribs w/ pa chest bilateral", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 135.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 216.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 216.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 216.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam ribs/chest4/> vws", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 271.00, "discounted_cash": 135.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 216.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 216.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 216.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam breastbone 2/>vws", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr sternum minimum 2 views", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray strenoclavic jt 3/>vws", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 51.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 82.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 82.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 82.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr sternoclavicular joint(s)", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 51.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 82.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 82.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 82.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "71250 ct chest w/o contrast", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1490.00, "discounted_cash": 745.00, "minimum": 229.16, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1261.60, 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1261.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1261.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "71270 ct thorax w/ & w/o contrast", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1640.00, "discounted_cash": 820.00, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 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Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct thorax w/o & w/dye", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1640.00, "discounted_cash": 820.00, "minimum": 444.05, "maximum": 465.06, "setting": "both", 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"standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct low dose lung screening", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 309.00, "discounted_cash": 154.50, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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"plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ct thorax lung cancer scr c-", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 309.00, "discounted_cash": 154.50, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 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108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, 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"standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri chest w/o dye", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 551.36, "maximum": 1025.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 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Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1025.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": 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"payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "72050 - radiologic examination spine cervical 4 or 5 views", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 242.00, "discounted_cash": 121.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 193.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 193.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 193.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam neck spine 4/5vws", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 242.00, "discounted_cash": 121.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 193.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 193.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 193.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72052 xr spine cervical comp w/ flex/ext", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 309.00, "discounted_cash": 154.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam neck spine 6/>vws", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 309.00, "discounted_cash": 154.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72070 xr spine thoracic 2 views", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam thorac spine 2vws", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72072 xr spine thoracic 3 views", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total 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"plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam thoracolmb 2/> vw", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr spine thoracolumbar 2 views", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "72081 xr scolios study", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 92.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": 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"payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 148.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 148.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 148.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam entire spi 1 vw", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 92.50, "minimum": 59.26, "maximum": 91.65, "setting": 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"standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 148.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 148.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 148.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam entire spi 2/3 vw", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr spine scoliosis study standing", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72083 scoliosis study (4 or 5 views)", "code_information": [ { "code": "72083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 220.00, "discounted_cash": 110.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 176.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 176.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 176.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam entire spi 4/5 vw", "code_information": [ { "code": "72083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 220.00, "discounted_cash": 110.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 176.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 176.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 176.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72084 radiologic examination spine entire thoracic 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"standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam l-s spine 2/3 vws", "code_information": [ { "code": "72100", "type": "CPT" } ], 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"standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, 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"Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam l-2 spine 4/>vws", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72114 xr spine lumbosacral complete w/ bending", "code_information": [ { "code": "72114", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 309.00, "discounted_cash": 154.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 247.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72120 radiologic examination spine lumbosacral; bending views only 2 or 3 views", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray bend only l-s spine", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72125 ct:spine cerv w/o-contr", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1468.00, "discounted_cash": 734.00, "minimum": 229.16, "maximum": 386.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1174.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1174.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1174.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct neck spine w/o dye", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1468.00, "discounted_cash": 734.00, "minimum": 229.16, "maximum": 386.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1174.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1174.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1174.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "72126 ct of the c-spine w/contrast", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1484.00, "discounted_cash": 742.00, "minimum": 386.60, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": 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"standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1187.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1187.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1187.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct neck spine w/dye", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1484.00, "discounted_cash": 742.00, "minimum": 386.60, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1187.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1187.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1187.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "72127 spine cervical w/ + w/o contrast", "code_information": [ { "code": "72127", "type": "CPT" } ], 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, 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"standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "72128 ct:spine thor w/o", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1048.00, "discounted_cash": 524.00, "minimum": 229.16, "maximum": 386.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 838.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 838.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 838.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct chest spine w/o dye", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1048.00, "discounted_cash": 524.00, "minimum": 229.16, "maximum": 386.60, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 838.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 838.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct chest spine w/dye", "code_information": [ { "code": "72129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1311.00, "discounted_cash": 655.50, "minimum": 386.60, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", 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444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1137.60, 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"29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct lumbar spine w/o & w/dye", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1507.00, "discounted_cash": 753.50, "minimum": 386.60, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 386.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Mri cervical spine w/o contrast", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 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Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"29030748", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { 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"payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri lumbar spine w/o dye", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 441.85, "maximum": 562.39, "setting": "both", "payers_information": [ 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562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": 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} ] } ] }, { "description": "Mri lumbar spine w contrast", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 441.85, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri lumbar spine w/dye", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 441.85, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri cervical spine w/wo contrast", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 441.85, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri lumbar spine w/o & w/dye", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 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"plan_name": "29030748", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" 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"payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 441.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1648.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1648.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1648.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mr angio spine w/o&w/dye", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2060.00, "discounted_cash": 1030.00, "minimum": 441.85, "maximum": 441.85, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of pelvis", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72190 xr pelvis complete minimum 3 views", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.00, "discounted_cash": 94.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of pelvis", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.00, "discounted_cash": 94.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angio pelvis", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 444.05, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": 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billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": 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"payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct pelvis w/dye", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1491.00, "discounted_cash": 745.50, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous 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"29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "72194 ct of the pelvis with and without contrast", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1576.00, "discounted_cash": 788.00, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1260.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1260.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1260.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct pelvis w/o & w/dye", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1576.00, "discounted_cash": 788.00, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare 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"fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "72198 mra of pelvis", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1862.00, "discounted_cash": 931.00, "minimum": 2154.06, "maximum": 3539.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 1489.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1489.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mr angio pelvis w/o & w/dye", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1862.00, "discounted_cash": 931.00, "minimum": 2154.06, "maximum": 3539.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2615.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3539.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1489.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1489.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1489.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "72200 xr sacroiliac joints 1 or 2 views tech charge", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam si joints", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "72202 xr sacroiliac joints minimum 3 views", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam si joints 3/> vws", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam sacrum tailbone", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr sacrum/coccyx minimum 2 views", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of collar bone", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 120.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr clavicle bilateral", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 120.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr clavicle left", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73000 xr clavicle right tech charge", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73010 xr scapula", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of shoulder blade", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr scapula left", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr scapula right", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of shoulder", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 77.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Bl 73020 xr shoulder 1 view", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 77.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73020 xr shoulder 1 view right", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 77.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of shoulder", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.00, "discounted_cash": 147.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr shoulder 3 views left", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.00, "discounted_cash": 147.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr shoulder 2 views left", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr shoulder 2 views right", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast x-ray of shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram shoulder left", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram shoulder right", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 364.46, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of shoulders", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr ac joints w/ or w/o weights bilateral", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of humerus", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 120.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr humerus bilateral", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 120.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr humerus min 2 views left", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 69.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73060 xr humerus right", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 69.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of elbow", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.00, "discounted_cash": 91.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr elbow 2 views left", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.00, "discounted_cash": 91.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73070 xr elbow 2 views left", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { 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"28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73070 xr elbow 2 views right tech charge", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.00, "discounted_cash": 91.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", 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Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of elbow", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr elbow 3 views bilateral", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr elbow 3 views left", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73080 xr elbow complete right", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast x-ray of elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 848.00, "discounted_cash": 424.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram elbow left", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 848.00, "discounted_cash": 424.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of forearm", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr forearm 2 views bilateral", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr forearm 2 views left", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73090 xr forearm 2 views right", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of wrist", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 80.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Bl73100 xr wrist 2 views", "code_information": [ { "code": "73100", "type": "CPT" } ], 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Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73100 - xr wrist 2 views rt", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 80.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", 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"plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of wrist", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.00, "discounted_cash": 91.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee 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"standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr wrist 2 views bilateral", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { 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"28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73110 xr wrist complete left min 3 views", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", 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Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr wrist 2 views right", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73115 wrist arthrogram", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3840.00, "discounted_cash": 1920.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3072.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3072.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3072.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast x-ray of wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3840.00, "discounted_cash": 1920.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3072.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3072.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3072.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram wrist right", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 364.46, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of hand", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 37.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "73120 xr hand 2 views left", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 37.50, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "73120 xr hand 2 views right", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 37.50, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of hand", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.00, "discounted_cash": 147.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hand min 3 views left", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.00, "discounted_cash": 147.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hand 2 views bilateral", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hand 2 views left", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73130 xr hand complete rt", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of finger(s)", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73140 xr finger 2 views left", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr finger right", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73200 ct upper extremity w/o contrast", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 882.00, "discounted_cash": 441.00, "minimum": 229.16, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct upper extremity w/o dye", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 882.00, "discounted_cash": 441.00, "minimum": 229.16, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct elbow w/o contrast bilateral", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1626.00, "discounted_cash": 813.00, "minimum": 229.16, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1300.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1300.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1300.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct humerus w/o contrast left", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 882.00, "discounted_cash": 441.00, "minimum": 229.16, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct hand w/o contrast right", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 882.00, "discounted_cash": 441.00, "minimum": 229.16, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 705.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct upper extremity w/dye", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1990.00, "discounted_cash": 995.00, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct elbow w/ contrast bilateral", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1990.00, "discounted_cash": 995.00, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct wrist w/ contrast left", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1168.00, "discounted_cash": 584.00, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 934.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 934.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 934.40, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 934.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 934.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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"standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", 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444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, 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billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "73202 ct shoulder w/ + w/o contrast bilateral", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1905.00, "discounted_cash": 952.50, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1524.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1524.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1524.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct shoulder w/ + w/o contrast left", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1270.00, "discounted_cash": 635.00, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct forearm w/ + w/o contrast right", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1270.00, "discounted_cash": 635.00, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1016.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angio upr extrm w/o&w/dye", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 767.00, "discounted_cash": 383.50, "minimum": 444.05, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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{ "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angiography upper extremity right", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 767.00, "discounted_cash": 383.50, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { 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"methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Mri upper extremity w/o contrast", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 551.36, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri upper extremity w/o dye", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, 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schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri ue non joint w/o contrast left", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1458.00, "discounted_cash": 729.00, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri humerus w/o contrast right", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1458.00, "discounted_cash": 729.00, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "73219 mri:upper ext w/cont rt", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2187.00, "discounted_cash": 1093.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri upper extremity w/dye", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2187.00, "discounted_cash": 1093.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri forearm w/ contrast left", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2186.00, "discounted_cash": 1093.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri humerus w/ contrast right", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2186.00, "discounted_cash": 1093.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri upper extremity w/wo contrast", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri uppr extremity w/o&w/dye", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, 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"methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri hand w/ + w/o contrast left", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2915.00, "discounted_cash": 1457.50, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri humerus w/ + w/o contrast right", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2915.00, "discounted_cash": 1457.50, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2332.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri joint upr extrem w/o dye", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 498.83, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": 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"payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri upper extremity joint w/o contrast", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri elbow w/o contrast left", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3696.00, "discounted_cash": 1848.00, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2956.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2956.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2956.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri shoulder w/o contrast right", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3696.00, "discounted_cash": 1848.00, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2956.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2956.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2956.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri arthrogram shoulder", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 498.83, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, 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498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri wrist w/ contrast left", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1928.00, "discounted_cash": 964.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri elbow w/ contrast right", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1928.00, "discounted_cash": 964.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri joint upr extr w/o&w/dye", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 498.83, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri upper extremity joint w/wo contrast", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 498.83, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri shoulder w/ + w/o contrast left", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 1125.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri elbow w/ + w/o contrast right", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 1125.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "73225 cath lab angiography brachial retrograde.", "code_information": [ { "code": "73225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 2154.06, "maximum": 3539.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2615.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3539.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mr angio upr extr w/o&w/dye", "code_information": [ { "code": "73225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 2154.06, "maximum": 3539.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2615.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3539.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mra upper extremity right", "code_information": [ { "code": "73225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1834.00, "discounted_cash": 917.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1467.20, "methodology": "percent of total billed charges", "modifiers": "RT" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1467.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1467.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "73501 xr hip 1 view", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam hip uni 1 view", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hip 1 view bilateral", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hip 1 view left", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hip 1 view right", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam hip uni 2-3 views", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 160.00, "discounted_cash": 80.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl 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Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hip 2-3 views left w/ pelvis", "code_information": [ { "code": "73502", "type": "CPT" 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Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam hips bi 2 views", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": 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"standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hip w/ pelvis 2v bilateral", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr hip complete bilateral", "code_information": [ { "code": "73521", "type": "CPT" } ], 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Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "73522 xr hip ortho bilateral", "code_information": [ { "code": "73522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.00, "discounted_cash": 139.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 222.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam hips bi 3-4 views", "code_information": [ { "code": "73522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.00, "discounted_cash": 139.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 222.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 222.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 222.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, 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"29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 540.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 540.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 540.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam hips bi 5/> views", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 676.00, "discounted_cash": 338.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 540.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 540.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 540.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast x-ray of hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram hip left", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of femur 2/>", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", 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"payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr femur 2 views left", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": 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Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr femur 2 views bilateral", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 301.00, "discounted_cash": 150.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73552 xr femur left", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total 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United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73552 xr femur right", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of knee 1 or 2", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73560 xr knee one or two views left", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr knee 2 views right", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", 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schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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"standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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"standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", 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Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73562 xr knee 3 views left", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", 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"standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr knee 3 views right", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam knee 4 or more", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 294.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 294.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 294.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr knee complete bilateral", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 368.00, "discounted_cash": 184.00, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 294.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 294.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 294.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr knee complete left", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "73564 xr knee complete right", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "73565 xr knee 1 or 2 views bilateral standing", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 175.00, "discounted_cash": 87.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of knees", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 175.00, "discounted_cash": 87.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast x-ray of knee joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 848.00, "discounted_cash": 424.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram knee", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 848.00, "discounted_cash": 424.00, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of lower leg", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 307.00, "discounted_cash": 153.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 245.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 245.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 245.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr tibia/fibula bilateral", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 307.00, "discounted_cash": 153.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 245.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 245.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr tibia/fibula left", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 179.00, "discounted_cash": 89.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 143.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 143.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 143.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr tibia/fibula right", 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"fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of leg infant", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.00, "discounted_cash": 98.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr le infant min 2 views bilateral", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.00, "discounted_cash": 98.50, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr le infant min 2 views left", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.00, "discounted_cash": 98.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr le infant min 2 views right", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.00, "discounted_cash": 98.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 157.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of ankle", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73600 xr ankle 2 views left tech charge", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr ankle 2 views right", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73610 xr ankle complete", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of ankle", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr ankle complete bilateral", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr ankle complete left", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr ankle complete right", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast x-ray of ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram ankle left", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 364.46, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr arthrogram ankle right", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 364.46, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of foot", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73620 xr foot 2 views left tech charge", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": 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"28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr foot 2 views right", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { 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"plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of foot", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr foot complete bilateral", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr foot complete left", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": 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"type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of heel", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr calcaneous bilateral", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73650 xr calcaneous left", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr calcaneous min 2 views right", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73650 xr calcaneous right", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam of toe(s)", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr toes bilateral", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 138.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 220.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73660 xr toes 2 views left", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr toes right", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "73700 ct lower extremity w/o contrast", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1115.00, "discounted_cash": 557.50, "minimum": 229.16, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct lower extremity w/o dye", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1115.00, "discounted_cash": 557.50, "minimum": 229.16, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct hip w/o contrast bilateral", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1990.00, "discounted_cash": 995.00, "minimum": 229.16, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct lower extremity w/o contrast left", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1115.00, "discounted_cash": 557.50, "minimum": 229.16, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct knee w/o contrast right", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1115.00, "discounted_cash": 557.50, "minimum": 229.16, "maximum": 233.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 892.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct lower extremity w/ contrast right", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1367.00, "discounted_cash": 683.50, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct lower extremity w/dye", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1367.00, "discounted_cash": 683.50, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct ankle w/ contrast bilateral", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1990.00, "discounted_cash": 995.00, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct femur w/ contrast left", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1243.00, "discounted_cash": 621.50, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 994.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 994.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 994.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct tibia/fibula w/ contrast right", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1243.00, "discounted_cash": 621.50, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 994.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 994.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 994.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "73702 ct tib fib w/wo right and left", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1367.00, "discounted_cash": 683.50, "minimum": 444.05, "maximum": 465.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"29030748", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 465.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1093.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angio lwr extr w/o&w/dye", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 444.05, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angiography lower extremity left", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 444.05, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angiography lower extremity bilat", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Mri lower extremity w/o contrast", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 551.36, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", 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"type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 551.36, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, 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"methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri foot w/o contrast left", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1676.00, "discounted_cash": 838.00, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri tibia/fibula w/o contrast right", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1676.00, "discounted_cash": 838.00, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana 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Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri le non joint w/ contrast left", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1103.00, "discounted_cash": 551.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": 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"payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri lower extremity w/dye", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1103.00, "discounted_cash": 551.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc 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"standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri femur w/ contrast left", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1049.00, "discounted_cash": 524.50, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 839.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 839.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 839.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri tibia/fibula w/ contrast right", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1049.00, "discounted_cash": 524.50, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 839.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 839.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 839.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri femur w/ contrast bilat", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 872.37, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": 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"payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri lwr extremity w/o&w/dye", "code_information": [ 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Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri femur w/ + w/o contrast left", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { 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Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri femur w/ + w/o contrast right", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri jnt of lwr extre w/o dye", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 498.83, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, 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Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri ankle w/o contrast left", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", 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80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri knee w/o contrast right", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 551.36, "maximum": 562.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", 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"plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mri ankle w/ contrast left", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1928.00, "discounted_cash": 964.00, "minimum": 498.83, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", 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"methodology": "fee schedule" } ] } ] }, { "description": "Mri joint of lwr extr w/dye", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1928.00, "discounted_cash": 964.00, "minimum": 498.83, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee 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"payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri hip w/ contrast bilateral", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1990.00, "discounted_cash": 995.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", 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80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1592.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri knee w/ contrast left", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1928.00, "discounted_cash": 964.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1542.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri foot w/ contrast right", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1928.00, "discounted_cash": 964.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana 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"29030808", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 498.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3190.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3190.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3190.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri lower extremity joint w/wo contrast", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3190.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3190.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3190.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri foot w/ + w/o contrast left", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 1125.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mri ankle w/ + w/o contrast right", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 1125.00, "minimum": 872.37, "maximum": 889.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1800.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "Mr ang lwr ext w or w/o dye", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 2154.06, "maximum": 3539.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2615.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3539.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mra lower extremity", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3993.00, "discounted_cash": 1996.50, "minimum": 2154.06, "maximum": 3539.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2615.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3539.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3194.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "74018 xray abdomen kub 1 view", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 69.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam abdomen 1 view", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 69.00, "minimum": 59.26, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 110.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "74019 xray of abdomen 2 views", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam abdomen 2 views", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "74021-radiologic exam chest-3 or more views", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 120.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray exam abdomen 3+ views", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 120.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "74150 ct:abdomen w/o c", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1368.00, "discounted_cash": 684.00, "minimum": 229.16, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct abdomen w/o dye", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1368.00, "discounted_cash": 684.00, "minimum": 229.16, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1094.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "74160 ct:abdomen w/cont", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1567.00, "discounted_cash": 783.50, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1253.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1253.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1253.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct abdomen w/dye", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1567.00, "discounted_cash": 783.50, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1253.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1253.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1253.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "424741709 ct abd wo w con fs", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1640.00, "discounted_cash": 820.00, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct abdomen w/o & w/dye", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1640.00, "discounted_cash": 820.00, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "74174 cta abd/pel", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 364.46, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angio abd&pelv w/o&w/dye", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 364.46, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angio abdom w/o & w/dye", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 444.05, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angiography abdomen", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 444.05, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct abd & pelvis w/o contrast", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3470.00, "discounted_cash": 1735.00, "minimum": 229.16, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2776.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2776.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2776.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct chest/abd/pel w/o contrast", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3470.00, "discounted_cash": 1735.00, "minimum": 229.16, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 233.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2776.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2776.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2776.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 229.16, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 229.16, "methodology": "fee schedule" } ] } ] }, { "description": "Ct abd & pelv w/contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3645.00, "discounted_cash": 1822.50, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2916.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2916.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2916.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct chest/abd/pel w/ contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3645.00, "discounted_cash": 1822.50, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2916.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2916.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2916.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct abd & pelv 1/> regns", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3819.00, "discounted_cash": 1909.50, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct chest /abdomen/pelvis w + w/o contras", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3819.00, "discounted_cash": 1909.50, "minimum": 444.05, "maximum": 571.16, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 571.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "Ct hip w/ + w/o contrast bilateral", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2790.00, "discounted_cash": 1395.00, "minimum": 444.05, "maximum": 452.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 444.05, "methodology": "fee schedule", "modifiers": "50" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 452.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2232.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2232.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2232.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 444.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 444.05, "methodology": "fee schedule" } ] } ] }, { "description": "74181- mri abdomen w/o contrast", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3630.00, "discounted_cash": 1815.00, "minimum": 551.36, "maximum": 1170.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1170.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1170.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1170.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1170.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1170.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1170.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", 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"standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2904.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2904.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, 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] } ] }, { "description": "X-ray xm swlng funcj c+", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 118.50, "minimum": 181.67, "maximum": 286.79, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "Xr fluoro modified esophagram", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 118.50, "minimum": 181.67, "maximum": 286.79, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 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"29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray xm upr gi trc 1cntrst", "code_information": [ { "code": "74240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 299.00, "discounted_cash": 149.50, "minimum": 181.67, "maximum": 286.79, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "Xr upper gi", "code_information": [ { "code": "74240", "type": "CPT" } ], 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"standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 239.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray xm upr gi trc 2cntrst", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.00, "discounted_cash": 156.00, "minimum": 181.67, "maximum": 286.79, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 249.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 249.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 249.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "Xr upper gi w/ air contrast", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.00, "discounted_cash": 156.00, "minimum": 181.67, "maximum": 286.79, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 249.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 249.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 249.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "Tah xr fluoro ugi w/ small bowel", "code_information": [ { "code": "74248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 508.00, "discounted_cash": 254.00, "minimum": 59.26, "maximum": 59.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 406.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 406.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 406.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray sm int f-thru std", "code_information": [ { "code": "74248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 508.00, "discounted_cash": 254.00, "minimum": 59.26, "maximum": 59.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 406.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 406.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 406.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "X-ray xm sm int 1cntrst std", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 255.00, "discounted_cash": 127.50, "minimum": 181.67, "maximum": 286.79, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 286.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 204.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 204.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 204.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "Xr small bowel series", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 255.00, "discounted_cash": 127.50, "minimum": 181.67, "maximum": 286.79, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 286.79, "methodology": "fee 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total billed charges" } ] } ] }, { "description": "Contrst x-ray urinary tract", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.00, "discounted_cash": 219.50, "minimum": 181.67, "maximum": 492.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": 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"payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "Xr fluoro ivp", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.00, "discounted_cash": 219.50, "minimum": 181.67, "maximum": 492.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { 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"29030808", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr nephrostogram/loopogram", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 848.00, "discounted_cash": 424.00, "minimum": 364.46, "maximum": 492.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 678.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast x-ray bladder", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.00, "discounted_cash": 219.50, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Xr cystogram non voiding", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.00, "discounted_cash": 219.50, "minimum": 204.14, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray urethra/bladder", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.00, "discounted_cash": 219.50, "minimum": 204.14, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 351.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Xr cystogram voiding", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 439.00, "discounted_cash": 219.50, "minimum": 204.14, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee 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"Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "75557 mri cardiac imaging w/out contrast", "code_information": [ { "code": "75557", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3267.00, "discounted_cash": 1633.50, "minimum": 551.36, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee 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schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Cardiac mri for morph", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3413.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", 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Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2613.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "75565 velocity flow mapping", "code_information": [ { "code": "75565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 250.00, "discounted_cash": 125.00, "minimum": 981.45, "maximum": 981.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 981.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": 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total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ct cardiac calcium score", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 163.00, "discounted_cash": 81.50, "minimum": 89.86, "maximum": 492.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Ct hrt w/o dye w/ca test", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 163.00, "discounted_cash": 81.50, "minimum": 89.86, "maximum": 492.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 492.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans 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"plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" } ] } ] }, { "description": "75625 xa abd aortogram s&i", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Contrast exam abdominl aorta", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "75630 xa abd aortogram& runoff s&i", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray aorta leg arteries", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "75635 angio abd aorta + iliofemoral le runo", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 181.67, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "Ct angio abdominal arteries", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 181.67, "maximum": 627.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 627.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 181.67, "methodology": "fee schedule" } ] } ] }, { "description": "75710 xa angiographybrachialretrograde s&i", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2678.00, "discounted_cash": 1339.00, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": 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"payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Artery x-rays arm/leg", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2678.00, "discounted_cash": 1339.00, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2142.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "75716 xa arteriogram bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, 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schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Artery x-rays arms/legs", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "75726 xa angio visceral selective s & i", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 204.14, "maximum": 5626.98, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5626.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5626.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3428.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5516.65, "methodology": "fee schedule" } ] } ] }, { "description": "Artery x-rays abdomen", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4285.00, "discounted_cash": 2142.50, "minimum": 204.14, 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3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", 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"plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee 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"36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Artery x-rays lung", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1683.00, "discounted_cash": 841.50, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1346.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1346.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1346.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "75774 additional each vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 951.00, "discounted_cash": 475.50, "minimum": 204.14, "maximum": 204.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 760.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 760.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 760.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Artery x-ray each vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 951.00, "discounted_cash": 475.50, "minimum": 204.14, "maximum": 204.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 760.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 760.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 760.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Vein x-ray arm/leg", "code_information": [ { "code": "75820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 857.00, "discounted_cash": 428.50, "minimum": 204.14, "maximum": 1617.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "75822 xa venogram extrem bil", "code_information": [ { "code": "75822", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1339.00, "discounted_cash": 669.50, "minimum": 204.14, "maximum": 1617.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Vein x-ray arms/legs", "code_information": [ { "code": "75822", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1339.00, "discounted_cash": 669.50, "minimum": 204.14, "maximum": 1617.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1071.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "75825 xa venogram ivc", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2162.00, "discounted_cash": 1081.00, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "Vein x-ray trunk", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2162.00, "discounted_cash": 1081.00, "minimum": 204.14, "maximum": 3276.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3276.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1729.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3212.10, "methodology": "fee schedule" } ] } ] }, { "description": "75827 venogram svc", "code_information": [ { "code": "75827", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1500.00, "discounted_cash": 750.00, "minimum": 204.14, "maximum": 1617.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "Vein x-ray chest", "code_information": [ { "code": "75827", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1500.00, "discounted_cash": 750.00, "minimum": 204.14, "maximum": 1617.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 204.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1617.03, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 515.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 515.20, 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"standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us echoencephalogram", "code_information": [ { "code": "76506", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 339.00, "discounted_cash": 169.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 271.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76536 - ultrasound soft tissues of head and neck (eg thyroid parathyroid parotid) real time wit", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 370.00, "discounted_cash": 185.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam of head and neck", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 370.00, "discounted_cash": 185.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us chest", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.00, "discounted_cash": 166.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam chest", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.00, "discounted_cash": 166.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76641 us:breast complete unilat", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 210.00, "discounted_cash": 105.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 168.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 168.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 168.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ultrasound breast complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 210.00, "discounted_cash": 105.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 168.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 168.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 168.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ultrasound breast limited", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 209.00, "discounted_cash": 104.50, "minimum": 89.86, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 167.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 167.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 167.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Us breast left limited", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 209.00, "discounted_cash": 104.50, "minimum": 89.86, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 167.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 167.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 167.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "76642 us breast limited unilateral", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 414.00, "discounted_cash": 207.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 331.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 331.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 331.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "76642 us:breast limited unilat right", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 414.00, "discounted_cash": 207.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 331.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 331.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 331.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "76700 - ultrasound abdominal real time with image documentation; complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 542.00, "discounted_cash": 271.00, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 433.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 433.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 433.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam abdom complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 542.00, "discounted_cash": 271.00, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 433.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 433.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 433.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "76705 limited abdominal ultrasound", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 470.00, "discounted_cash": 235.00, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { 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}, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 376.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Aaa screening", "code_information": [ { "code": 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{ "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76770 us:aorta u/s", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 652.00, "discounted_cash": 326.00, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", 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schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 521.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 521.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam abdo back wall comp", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 652.00, "discounted_cash": 326.00, 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"Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 521.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 521.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Tah us renal limited", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 279.00, "discounted_cash": 139.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", 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"Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 259.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 259.20, "methodology": "percent of total billed charges" }, 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{ "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 221.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 221.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 221.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, 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Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us ob < 14 weeks multi", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 221.06, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "76805 us ob complete", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 348.00, "discounted_cash": 174.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 278.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 278.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 278.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ob us >= 14 wks sngl fetus", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 348.00, "discounted_cash": 174.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 278.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 278.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 278.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ob us >= 14 wks addl fetus", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 425.00, "discounted_cash": 212.50, "minimum": 221.06, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 340.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 340.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 340.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Us ob > 14 weeks multi", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 425.00, "discounted_cash": 212.50, "minimum": 221.06, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 340.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 340.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 340.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "76815 ultrasound pregnant uterus limited", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 410.00, "discounted_cash": 205.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ob us limited fetus(s)", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 410.00, "discounted_cash": 205.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ob us follow-up per fetus", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us ob follow-up/repeat", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76817 us pregnancy transvaginal", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.00, "discounted_cash": 132.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 211.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 211.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 211.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Transvaginal us obstetric", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 264.00, "discounted_cash": 132.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 211.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 211.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 211.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Fetal biophys profil w/o nst", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 410.00, "discounted_cash": 205.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us fetal biophysical profile", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 410.00, "discounted_cash": 205.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 328.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Umbilical artery echo", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us doppler fetal umbilical entry", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 108.52, "maximum": 221.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 221.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Tah us transvaginal", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.00, "discounted_cash": 123.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Transvaginal us non-ob", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.00, "discounted_cash": 123.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76856 us pelvic complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 432.00, "discounted_cash": 216.00, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 345.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 345.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 345.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam pelvic complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 432.00, "discounted_cash": 216.00, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 345.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 345.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 345.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Us bladder w/pre and post void", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 283.00, "discounted_cash": 141.50, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam pelvic limited", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 283.00, "discounted_cash": 141.50, "minimum": 208.65, "maximum": 319.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 226.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 312.79, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam scrotum", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 476.00, "discounted_cash": 238.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 380.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 380.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 380.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us scrotum (contents)", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 476.00, "discounted_cash": 238.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 380.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 380.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 380.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Ultrasound transrectal", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 318.00, "discounted_cash": 159.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 254.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 254.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 254.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us transrectal", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 318.00, "discounted_cash": 159.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 254.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 254.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 254.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76881 us compl joint r-t w/img", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 361.00, "discounted_cash": 180.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 288.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 288.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 288.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us compl joint r-t w/img", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 361.00, "discounted_cash": 180.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, 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"29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 288.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 288.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us lmtd jt/nonvasc xtr strux", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 350.00, "discounted_cash": 175.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", 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"standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us soft tissue - groin", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 350.00, "discounted_cash": 175.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 280.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76882 ultrasound limited joint lt", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 349.00, "discounted_cash": 174.50, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "76882 ultrasound limited joint rt", "code_information": [ { "code": "76882", "type": "CPT" } ], 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Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 279.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us exam infant hips dynamic", "code_information": [ { "code": "76885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.00, "discounted_cash": 123.00, "minimum": 89.86, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Us hips infant dynamic", "code_information": [ { "code": "76885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.00, "discounted_cash": 123.00, "minimum": 89.86, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", 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}, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 185.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 181.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 319.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 312.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, 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"standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Seq 3d/tomo unilateral", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 67.50, "minimum": 301.24, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 108.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Breast tomosynthesis bi", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 41.50, "minimum": 47.29, "maximum": 301.24, "setting": "both", "payers_information": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.29, "methodology": "fee schedule" } ] } ] }, { "description": "Seq 3d/tomo screening", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 41.50, "minimum": 47.29, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.29, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.29, "methodology": "fee schedule" } ] } ] }, { "description": "Dx mammo incl cad uni", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 111.36, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 113.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 113.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 111.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 111.36, "methodology": "fee schedule" } ] } ] }, { "description": "Ma diag lt w/ cad.", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges", "modifiers": "LT" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ma diag rt w/ cad.", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges", "modifiers": "RT" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dx mammo incl cad bi", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 295.00, "discounted_cash": 147.50, "minimum": 140.27, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 143.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 143.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 140.27, "methodology": "fee schedule" } ] } ] }, { "description": "Ma diag bil w/ cad.", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 295.00, "discounted_cash": 147.50, "minimum": 140.27, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 143.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 143.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 140.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 140.27, "methodology": "fee schedule" } ] } ] }, { "description": "Ma routine screen bil w/ cad.", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 120.50, "minimum": 113.51, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 115.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 115.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 113.51, "methodology": "fee schedule" } ] } ] }, { "description": "Scr mammo bi incl cad", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 120.50, "minimum": 113.51, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 115.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 115.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 113.51, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 113.51, "methodology": "fee schedule" } ] } ] }, { "description": "77071 xr stress view tech charge", "code_information": [ { "code": "77071", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "X-ray stress view", "code_information": [ { "code": "77071", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Xr manual stress application to joint", "code_information": [ { "code": "77071", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "77072 xr bone age studies tech charge", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": 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Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-rays for bone age", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", 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"methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-rays bone length studies", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 206.00, "discounted_cash": 103.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr bone length studies scanograms", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 206.00, "discounted_cash": 103.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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"payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-rays bone survey limited", "code_information": [ { "code": "77074", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 215.50, "minimum": 59.26, "maximum": 110.69, 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"29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr bone survey complete", "code_information": [ { "code": "77074", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 431.00, "discounted_cash": 215.50, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-rays bone survey complete", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 554.00, "discounted_cash": 277.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr bone survey limited (mets)", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 554.00, "discounted_cash": 277.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 443.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "X-rays bone survey infant", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 272.00, "discounted_cash": 136.00, "minimum": 59.26, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 217.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 217.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 217.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Xr bone survey infant", "code_information": [ { "code": "77076", "type": 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"standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 217.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 217.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 217.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Bd dexa axial scan", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 314.00, "discounted_cash": 157.00, "minimum": 93.39, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 251.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 251.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 251.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Dxa bone density axial", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 314.00, "discounted_cash": 157.00, "minimum": 93.39, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 251.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 251.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 251.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Bd dexa appendicular", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 136.00, "discounted_cash": 68.00, "minimum": 89.86, "maximum": 93.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 108.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 108.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 108.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Dxa bone density/peripheral", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 136.00, "discounted_cash": 68.00, "minimum": 89.86, "maximum": 93.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare 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373.58, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 373.58, "methodology": "fee schedule" } ] } ] }, { "description": "Set radiation therapy field", "code_information": [ { "code": "77290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1030.00, "discounted_cash": 515.00, "minimum": 373.58, "maximum": 1032.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1032.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1032.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1032.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1032.83, "methodology": "fee schedule" }, { "payer_name": 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Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 135.49, "methodology": "fee schedule" } ] } ] }, { "description": "Radiation treatment aid(s)", "code_information": [ { "code": "77332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 515.00, "discounted_cash": 257.50, "minimum": 135.49, "maximum": 220.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 220.18, 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Medicare", "plan_name": "28186619", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": 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] } ] }, { "description": "Radonc-teletherapv devicesintermediate tech", "code_information": [ { "code": "77333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 721.00, "discounted_cash": 360.50, "minimum": 135.49, "maximum": 220.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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"30770134", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 373.58, "methodology": "fee schedule" } ] } ] }, { "description": "Radonc-teletherapv devices complexe tech", "code_information": [ { "code": "77334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 220.18, "maximum": 381.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 220.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", 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"Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 373.58, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 373.58, "methodology": "fee schedule" } ] } ] }, { "description": "Radiation physics consult", "code_information": [ { "code": "77336", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.00, "discounted_cash": 151.00, "minimum": 135.49, "maximum": 229.76, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 241.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 241.60, 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"29030731", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 241.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 241.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 241.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 135.49, "methodology": "fee schedule" } ] } ] }, { "description": "Design mlc device for imrt", "code_information": [ { "code": "77338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1545.00, "discounted_cash": 772.50, "minimum": 373.58, "maximum": 1041.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 633.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 905.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 905.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 633.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 135.49, "methodology": "fee schedule" } ] } ] }, { "description": "Radonc-special radiatiom physics consult tech", "code_information": [ { "code": "77370", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 302.00, "discounted_cash": 151.00, "minimum": 135.49, "maximum": 229.76, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 229.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1037.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1037.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 590.34, "methodology": "fee schedule" } ] } ] }, { "description": "Radonc-imrt complex", "code_information": [ { "code": "77386", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1297.00, "discounted_cash": 648.50, "minimum": 590.34, "maximum": 1041.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 633.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 905.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 905.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 633.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 769.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1041.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 602.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 602.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1037.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1037.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1037.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 590.34, "methodology": "fee schedule" } ] } ] }, { "description": "Guidance for radj tx dlvr", "code_information": [ { "code": "77387", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 77.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Radonc-steroscopic x-ray guidence tech", "code_information": [ { "code": "77387", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 77.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 124.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "77399 unlisted procedure medical radiation physics", "code_information": [ { "code": "77399", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 600.00, "discounted_cash": 300.00, "minimum": 109.81, "maximum": 138.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 480.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 480.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 480.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 135.49, "methodology": "fee schedule" } ] } ] }, { "description": "External radiation dosimetry", "code_information": [ { "code": "77399", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 600.00, "discounted_cash": 300.00, "minimum": 109.81, "maximum": 138.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 109.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 138.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 480.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 480.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 480.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 135.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 135.49, "methodology": "fee schedule" } ] } ] }, { "description": "Radiation treatment delivery", "code_information": [ { "code": "77401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 394.00, "discounted_cash": 197.00, "minimum": 111.75, "maximum": 863.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 637.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 863.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 111.75, "methodology": "fee schedule" } ] } ] }, { "description": "Radonc-77401 (radiation treatment delivery superficial or ortho voltage per day)", "code_information": [ { "code": "77401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 394.00, "discounted_cash": 197.00, "minimum": 111.75, "maximum": 863.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 637.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 863.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 111.75, "methodology": "fee schedule" } ] } ] }, { "description": "Radiation treatment delivery", "code_information": [ { "code": "77402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.00, "discounted_cash": 147.00, "minimum": 111.75, "maximum": 863.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 637.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 863.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 111.75, "methodology": "fee schedule" } ] } ] }, { "description": "Radonc-simple treatment delivery 6-10mev tech", "code_information": [ { "code": "77402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 294.00, "discounted_cash": 147.00, "minimum": 111.75, "maximum": 863.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 111.75, "methodology": "fee schedule" } ] } ] }, { "description": "Radiation treatment delivery", "code_information": [ { "code": "77407", "type": "CPT" } ], "standard_charges": [ { 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268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 273.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 273.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total 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Medicare", "plan_name": "29046131", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 268.38, "methodology": "fee schedule" } ] } ] }, { "description": "Radiation treatment delivery", "code_information": [ { "code": "77412", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 564.00, "discounted_cash": 282.00, "minimum": 268.38, "maximum": 1041.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 633.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 905.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 905.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 633.89, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 769.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1041.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 273.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 273.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 268.38, "methodology": "fee schedule" } ] } ] }, { "description": "Radonc-complex treatment- 3 or more sep 11-19mev tech", "code_information": [ { "code": "77412", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 564.00, "discounted_cash": 282.00, 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"Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 451.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 268.38, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 268.38, "methodology": "fee schedule" } ] } ] }, { "description": "77417 port verification", "code_information": [ { "code": "77417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 13.00, "minimum": 59.26, "maximum": 59.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": 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590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 602.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 602.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 659.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 590.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 659.20, "methodology": "percent of total 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 18929.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 13249.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 16089.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 21769.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 113.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": 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"29043841", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": 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{ "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 235.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 111.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 111.75, "methodology": "fee schedule" } ] } ] }, { "description": "Nm thyroid uptake multiple determinate", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 576.00, "discounted_cash": 288.00, 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"payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 460.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 460.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 460.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm parathyroid study", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 574.00, "discounted_cash": 287.00, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 459.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 459.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 459.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Parathyroid planar imaging", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 574.00, "discounted_cash": 287.00, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 459.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 459.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 459.20, 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"standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 428.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 549.32, "methodology": "fee schedule" } ] } ] }, { 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1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 560.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 560.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 655.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 655.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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"plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 655.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 655.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Hepatobiliary system imaging", "code_information": [ { "code": "78226", "type": "CPT" } ], 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"payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 724.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 724.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Hepatobil syst image w/drug", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 931.00, "discounted_cash": 465.50, "minimum": 549.32, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 744.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 744.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 744.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 549.32, "methodology": "fee schedule" } ] } ] }, { "description": "Nm hida scan w/ cck", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 931.00, "discounted_cash": 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Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 744.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 549.32, "methodology": "fee schedule" } ] } ] }, { "description": "Gastric emptying imag study", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 770.00, "discounted_cash": 385.00, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 616.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 616.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 616.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm gastric emptying study", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 770.00, "discounted_cash": 385.00, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": 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"standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 616.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 616.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Acute gi blood loss imaging", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 857.00, "discounted_cash": 428.50, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ 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418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm gi bleed scan", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 857.00, "discounted_cash": 428.50, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Meckels divert exam", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 761.00, "discounted_cash": 380.50, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 608.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 608.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 608.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm bowel image (meckel`s)", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 761.00, "discounted_cash": 380.50, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 608.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 608.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 608.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Bone imaging limited area", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 771.00, "discounted_cash": 385.50, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, 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"plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 616.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": 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410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 616.80, 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billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 616.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "78305 bone - multiple areas charge", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 800.00, "discounted_cash": 400.00, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, 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"standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Bone imaging multiple areas", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 800.00, "discounted_cash": 400.00, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 640.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Bone imaging whole body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1093.00, "discounted_cash": 546.50, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 874.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 874.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 874.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm bone imaging whole body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1093.00, "discounted_cash": 546.50, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 874.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 874.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 874.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Bone imaging 3 phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 659.00, "discounted_cash": 329.50, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 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"plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 527.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 527.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm bone three phase study", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 659.00, "discounted_cash": 329.50, "minimum": 410.08, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": 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"standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 527.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 527.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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Administration", "plan_name": "29042596", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" } ] } ] }, { "description": "Nm mpi scan", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3991.00, "discounted_cash": 1995.50, "minimum": 1228.66, "maximum": 1358.92, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1228.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1228.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1228.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 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Life", "plan_name": "30770266", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" } ] } ] }, { "description": "Ht musc image planar mult", "code_information": [ { "code": "78454", "type": 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80.0, "estimated_amount": 1928.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 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schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1928.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1332.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1928.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1928.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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}, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm cardiac blood pool gated single", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": 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410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Lung perfusion imaging", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1265.00, "discounted_cash": 632.50, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, 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"29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm pulmonary perfusion imaging", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1265.00, "discounted_cash": 632.50, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1012.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Lung ventilat&perfus imaging", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1318.00, "discounted_cash": 659.00, "minimum": 549.32, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl 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Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1054.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm brain imaging comp w/ vascular flow", "code_information": [ { "code": "78601", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 936.00, "discounted_cash": 468.00, "minimum": 410.08, "maximum": 630.74, "setting": "both", 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"standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 748.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 560.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 560.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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] } ] }, { "description": "Nm brain imaging vascular flow only", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 382.00, "discounted_cash": 191.00, "minimum": 549.32, "maximum": 630.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 630.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", 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charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 549.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 835.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl 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schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 674.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 674.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", 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}, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 738.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 738.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 738.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Rp loclzj tum 1 area 1 d img", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 923.00, "discounted_cash": 461.50, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 738.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 738.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 738.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Nm abscess loc/limited", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 964.00, "discounted_cash": 482.00, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", 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"standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 410.08, "methodology": "fee schedule" } ] } ] }, { "description": "Rp loclzj tum 2+area 1+d img", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 964.00, "discounted_cash": 482.00, "minimum": 410.08, "maximum": 1153.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1153.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 410.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 418.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1488.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1488.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1488.53, "methodology": "fee schedule" } ] } ] }, { "description": "Pet image w/ct lmtd", "code_information": [ { "code": "78814", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4820.00, "discounted_cash": 2410.00, "minimum": 1488.53, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1824.88, "methodology": 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"fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1861.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4055.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1824.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bcr/abl 1 gene rearrangement quantitative pcr qst", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 521.00, "discounted_cash": 260.50, "minimum": 163.96, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 163.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 167.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 167.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 163.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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"30770134", "standard_charge_dollar": 241.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 241.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 241.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 241.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 241.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans 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Medicare", "plan_name": "29046131", "standard_charge_dollar": 121.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 121.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 121.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 121.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 243.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 121.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 121.63, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 567.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 567.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 556.60, "methodology": "fee schedule" } ] } ] }, { "description": "Cystic fibrosis screen qst", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 250.45, "maximum": 567.73, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 567.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 567.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 556.60, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 556.60, "methodology": "fee schedule" } ] } ] }, { "description": "Cftr gene known fam variants", "code_information": [ { "code": "81221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.05, "discounted_cash": 121.53, "minimum": 97.22, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 99.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 99.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 194.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 194.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 194.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 97.22, "methodology": "fee schedule" } ] } ] }, { "description": "Cystic fibrosis d1152h mutation analysis qst", "code_information": [ { "code": "81221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.05, "discounted_cash": 121.53, "minimum": 97.22, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 99.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 99.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 194.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 194.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 194.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 97.22, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 97.22, "methodology": "fee schedule" } ] } ] }, { "description": "Cardio iq cyp2c19 genotype qst", "code_information": [ { "code": "81225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 291.36, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 297.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 297.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 291.36, "methodology": "fee schedule" } ] } ] }, { "description": "Cyp2c19 gene com variants", "code_information": [ { "code": "81225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 291.36, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 297.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 297.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 291.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 291.36, "methodology": "fee schedule" } ] } ] }, { "description": "Cyp2c9 gene com variants", "code_information": [ { "code": "81227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 437.03, "discounted_cash": 218.52, "minimum": 174.81, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 349.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 349.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 349.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.81, "methodology": "fee schedule" } ] } ] }, { "description": "Cytochrome p450 2c9 genotype qst", "code_information": [ { "code": "81227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 437.03, "discounted_cash": 218.52, "minimum": 174.81, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl 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Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 349.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 349.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.81, "methodology": "fee schedule" } ] } ] }, { "description": "Dpd gene mutation qst", "code_information": [ { "code": "81232", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 437.00, "discounted_cash": 218.50, "minimum": 174.81, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 349.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 349.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 349.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.81, "methodology": "fee schedule" } ] } ] }, { "description": "Dpyd gene common variants", "code_information": [ { "code": "81232", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 437.00, "discounted_cash": 218.50, "minimum": 174.81, "maximum": 445.22, 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"29045832", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 349.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 349.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 349.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.81, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.81, "methodology": "fee schedule" } ] } ] }, { "description": "F2 gene", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.00, "discounted_cash": 84.50, "minimum": 65.69, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 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"30770242", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 135.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 135.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 65.69, "methodology": "fee schedule" } ] } ] }, { "description": "Prothrombin (factor ii) mutation analysis qst", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.00, "discounted_cash": 84.50, "minimum": 65.69, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 67.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 67.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 135.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 135.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 135.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 65.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 65.69, "methodology": "fee schedule" } ] } ] }, { "description": "81241", "code_information": [ { "code": "81241", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.43, "discounted_cash": 91.72, "minimum": 73.37, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 146.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 73.37, "methodology": "fee schedule" } ] } ] }, { "description": "F5 gene", "code_information": [ { "code": "81241", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 183.43, "discounted_cash": 91.72, "minimum": 73.37, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 146.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 73.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 73.37, "methodology": "fee schedule" } ] } ] }, { "description": "Fmr1 gene detection", "code_information": [ { "code": "81243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 73.50, "minimum": 57.04, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 58.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 58.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 57.04, "methodology": "fee schedule" } ] } ] }, { "description": "Fragile x with reflex qst", "code_information": [ { "code": "81243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 73.50, "minimum": 57.04, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 58.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 58.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 57.04, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 57.04, "methodology": "fee schedule" } ] } ] }, { "description": "Hereditary hemochromatosis analysis qst", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 104.00, "minimum": 65.36, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 66.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 66.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 65.36, "methodology": "fee schedule" } ] } ] }, { "description": "Hfe gene", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 104.00, "minimum": 65.36, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 66.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 66.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 166.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 65.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 65.36, "methodology": "fee schedule" } ] } ] }, { "description": "Jak2 gene", "code_information": [ { "code": "81270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 364.00, "discounted_cash": 182.00, "minimum": 91.66, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 93.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 93.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 291.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 291.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 291.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 91.66, "methodology": "fee schedule" } ] } ] }, { "description": "Jak2 v617f qualitative w/reflex qst", "code_information": [ { "code": "81270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 364.00, "discounted_cash": 182.00, "minimum": 91.66, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 93.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 93.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 291.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 291.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 291.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 91.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 91.66, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only .jak2 ex 12 mutation", "code_information": [ { "code": "81279", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 463.00, "discounted_cash": 231.50, "minimum": 185.20, "maximum": 188.90, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 370.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 370.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 370.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 185.20, "methodology": "fee schedule" } ] } ] }, { "description": "Jak2 gene trgt sequence alys", "code_information": [ { "code": "81279", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 463.00, "discounted_cash": 231.50, "minimum": 185.20, "maximum": 188.90, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 370.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 370.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 370.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 185.20, "methodology": "fee schedule" } ] } ] }, { "description": "Mthfr gene", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 168.00, "discounted_cash": 84.00, "minimum": 65.34, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 66.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 66.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 134.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 134.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 134.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 65.34, "methodology": "fee schedule" } ] } ] }, { "description": "Mthfr dna mutation analysis qst", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 168.00, "discounted_cash": 84.00, "minimum": 65.34, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 66.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 66.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 134.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 134.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 134.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 65.34, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 65.34, "methodology": "fee schedule" } ] } ] }, { "description": "Chromos microarr postnat oligo snp qst", "code_information": [ { "code": "81299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 308.00, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 314.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 314.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 308.00, "methodology": "fee schedule" } ] } ] }, { "description": "Msh6 gene known variants", "code_information": [ { "code": "81299", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 308.00, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 314.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 314.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 308.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 308.00, "methodology": "fee schedule" } ] } ] }, { "description": "Mecp2 gene full seq", "code_information": [ { "code": "81302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1319.68, "discounted_cash": 659.84, "minimum": 250.45, "maximum": 538.43, "setting": "both", "payers_information": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1055.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1055.74, 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"standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1055.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1055.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 527.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 527.87, "methodology": "fee schedule" } ] } ] }, { "description": "81310 pl npm1 gene", "code_information": [ { "code": "81310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 637.00, "discounted_cash": 318.50, "minimum": 246.52, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, 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"payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 509.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 509.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 509.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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"payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 336.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 336.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 659.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 659.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 659.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 329.51, "methodology": "fee schedule" } ] } ] }, { "description": "Pdgfra mutation analysis qst", "code_information": [ { "code": "81314", "type": "CPT" } ], "standard_charges": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 336.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 336.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 659.02, "methodology": 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}, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 659.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 329.51, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 329.51, "methodology": "fee schedule" } ] } ] }, { "description": "Colovantage (methylated septin 9) qst", "code_information": [ { "code": "81327", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 240.00, "minimum": 192.00, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 195.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 195.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 192.00, "methodology": "fee schedule" } ] } ] }, { "description": "Sept9 gen prmtr mthyltn alys", "code_information": [ { "code": "81327", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 240.00, "minimum": 192.00, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 195.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 195.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 192.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 192.00, "methodology": "fee schedule" } ] } ] }, { "description": "Alpha-1 antitrypsin (aat) mutation analysis qst", "code_information": [ { "code": "81332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 69.50, "minimum": 43.65, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 44.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 44.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 43.65, "methodology": "fee schedule" } ] } ] }, { "description": "Serpina1 gene", "code_information": [ { "code": "81332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 69.50, "minimum": 43.65, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 44.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 44.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 43.65, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 43.65, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only .mpi mutation analysis", "code_information": [ { "code": "81338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.83, "discounted_cash": 187.92, "minimum": 150.33, "maximum": 153.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 300.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 300.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 300.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 150.33, "methodology": "fee schedule" } ] } ] }, { "description": "Mpl gene common variants", "code_information": [ { "code": "81338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.83, "discounted_cash": 187.92, "minimum": 150.33, "maximum": 153.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 300.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 300.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 300.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 150.33, "methodology": "fee schedule" } ] } ] }, { "description": "Ugt1a1 gene common variants", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 585.00, "discounted_cash": 292.50, "minimum": 234.00, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 238.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 238.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 468.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 468.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 468.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 234.00, "methodology": "fee schedule" } ] } ] }, { "description": "Ugt1a1 ta repeat qst", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 585.00, "discounted_cash": 292.50, "minimum": 234.00, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 238.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 238.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 468.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 468.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 468.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 234.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 234.00, "methodology": "fee schedule" } ] } ] }, { "description": "81355", "code_information": [ { "code": "81355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 13.00, "minimum": 88.20, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 89.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 89.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 88.20, "methodology": "fee schedule" } ] } ] }, { "description": "Vkorc1 gene", "code_information": [ { "code": "81355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 13.00, "minimum": 88.20, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 89.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 89.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 88.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 88.20, "methodology": "fee schedule" } ] } ] }, { "description": "Hla i typing 1 antigen lr", "code_information": [ { "code": "81374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 202.08, "discounted_cash": 101.04, "minimum": 74.33, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 75.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 75.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 161.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 161.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 161.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 74.33, "methodology": "fee schedule" } ] } ] }, { "description": "Hla-b51 determination qst", "code_information": [ { "code": "81374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 202.08, "discounted_cash": 101.04, "minimum": 74.33, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 75.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 75.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 161.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 161.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 161.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 74.33, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 74.33, "methodology": "fee schedule" } ] } ] }, { "description": "81376-hla typing for celiac disease", "code_information": [ { "code": "81376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 339.50, "discounted_cash": 169.75, "minimum": 122.22, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 124.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 124.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 271.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 271.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 271.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 122.22, "methodology": "fee schedule" } ] } ] }, { "description": "Hla ii typing 1 locus lr", "code_information": [ { "code": "81376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 339.50, "discounted_cash": 169.75, "minimum": 122.22, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 124.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 124.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 271.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 271.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 271.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 122.22, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 122.22, "methodology": "fee schedule" } ] } ] }, { "description": "Hla i typing 1 allele hr", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 425.75, "discounted_cash": 212.88, "minimum": 169.90, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 173.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 173.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 340.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 340.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 340.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 169.90, "methodology": "fee schedule" } ] } ] }, { "description": "Hla-b*58:01 typing qst", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 425.75, "discounted_cash": 212.88, "minimum": 169.90, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 173.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 173.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 340.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 340.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 340.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 169.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 169.90, "methodology": "fee schedule" } ] } ] }, { "description": "81382-hla typing for celiac disease", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 343.55, "discounted_cash": 171.78, "minimum": 123.68, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 126.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 126.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 274.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 274.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 274.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 123.68, "methodology": "fee schedule" } ] } ] }, { "description": "Hla ii typing 1 loc hr", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 343.55, "discounted_cash": 171.78, "minimum": 123.68, "maximum": 445.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 445.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 126.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 126.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 274.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 274.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 274.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 123.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 123.68, "methodology": "fee schedule" } ] } ] }, { "description": "Huntington disease mutation analysis qst", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.00, "discounted_cash": 187.50, "minimum": 137.00, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 139.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 139.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 300.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 300.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 300.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 137.00, "methodology": "fee schedule" } ] } ] }, { "description": "Mopath procedure level 2", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.00, "discounted_cash": 187.50, "minimum": 137.00, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 139.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 139.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 300.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 300.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 300.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 137.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 137.00, "methodology": "fee schedule" } ] } ] }, { "description": "81402", "code_information": [ { "code": "81402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 387.00, "discounted_cash": 193.50, "minimum": 150.33, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 309.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 309.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 309.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 150.33, "methodology": "fee schedule" } ] } ] }, { "description": "Mopath procedure level 3", "code_information": [ { "code": "81402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 387.00, "discounted_cash": 193.50, "minimum": 150.33, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 153.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 309.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 309.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 309.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 150.33, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 150.33, "methodology": "fee schedule" } ] } ] }, { "description": "81403", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 238.50, "minimum": 185.20, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 185.20, "methodology": "fee schedule" } ] } ] }, { "description": "Mopath procedure level 4", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 238.50, "minimum": 185.20, "maximum": 250.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 188.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 381.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 185.20, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 185.20, "methodology": "fee schedule" } ] } ] }, { "description": "Mopath procedure level 7", "code_information": [ { "code": "81406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 707.00, "discounted_cash": 353.50, "minimum": 250.45, "maximum": 288.54, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 250.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 282.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 288.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 288.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 282.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 282.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 282.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 282.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 4.35, "methodology": "fee schedule" } ] } ] }, { "description": "Assay bld/serum cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 26.00, "discounted_cash": 13.00, "minimum": 4.35, "maximum": 14.11, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 4.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 4.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 4.35, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 4.35, "methodology": "fee schedule" } ] } ] }, { "description": "Assay of chromium", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "minimum": 40.05, "maximum": 40.05, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": 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"29030808", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 40.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "82507", "code_information": [ { "code": "82507", "type": "CPT" } ], 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"standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assay of citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 95.00, "discounted_cash": 47.50, "minimum": 27.00, "maximum": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Collagen crossed linked n-telopeptide qst", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 73.50, "minimum": 39.12, "maximum": 39.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Collagen crosslinks", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 73.50, "minimum": 39.12, "maximum": 39.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 117.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", 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"standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3.93, "methodology": "fee schedule" } ] } ] }, { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 4.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 4.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3.93, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3.93, "methodology": "fee schedule" } ] } ] }, { "description": "Glucose 1 hour pp", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 17.50, "minimum": 4.75, "maximum": 14.11, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 4.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 4.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 4.75, "methodology": "fee schedule" } ] } ] }, { "description": "Glucose test", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 17.50, "minimum": 4.75, "maximum": 14.11, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 14.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 4.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 4.85, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 4.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 4.75, "methodology": "fee schedule" } ] } ] }, { "description": ".gtt glucose fasting", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.00, "discounted_cash": 39.50, "minimum": 12.87, "maximum": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 12.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 13.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 13.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 12.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 12.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 12.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 12.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 63.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 12.87, "methodology": "fee schedule" 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"standard_charge_dollar": 5.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, 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}, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vitamin k qst", 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"description": "Quantiferon-tb gold (client incubated) qst", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 39.12, "maximum": 39.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tb test cell immun measure", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 39.12, "maximum": 39.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "86580: subdermal admin - admin other charge", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "minimum": 23.58, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Tb intradermal test", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "minimum": 23.58, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Rpr (dx) w/refl titer and confirm testing qst", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 42.50, "minimum": 4.27, "maximum": 23.58, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 4.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 4.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 4.27, "methodology": "fee schedule" } ] } ] }, { "description": "Syphilis test non-trep qual", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 42.50, "minimum": 4.27, "maximum": 23.58, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 4.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 4.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 4.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 4.27, "methodology": "fee schedule" } ] } ] }, { "description": ".rpr titer qst", "code_information": [ { "code": "86593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 8.00, "minimum": 4.40, "maximum": 23.58, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 4.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 4.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl 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schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 109.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill abid", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 236.00, "discounted_cash": 118.00, "minimum": 23.58, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 188.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee 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"29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 188.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 188.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 188.80, "methodology": "percent of total billed charges" }, { 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"standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Dat poly tube", "code_information": [ { "code": "86880", "type": "CPT" } ], 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"standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Ref antibody titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 30.00, "minimum": 23.58, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 23.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": 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"standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 250.00, "discounted_cash": 125.00, "minimum": 8.01, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs 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"payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Blood typing serologic abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 250.00, "discounted_cash": 125.00, "minimum": 8.01, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 200.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Blood typing serologic rh(d)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 38.00, "minimum": 8.01, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": 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"estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Blood type antigen donor ea", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 48.00, "minimum": 8.01, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Reference abo/rh", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 48.00, "minimum": 8.01, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Blood typing patient serum", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 57.50, "minimum": 8.01, "maximum": 61.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Ref crossmatch", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 57.50, "minimum": 8.01, "maximum": 61.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only antigen testing product", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 14.50, "minimum": 8.01, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 23.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 23.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 23.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Blood typing rbc antigens", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 14.50, "minimum": 8.01, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": 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"standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 23.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 23.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Compatibility test antiglob", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 251.00, "discounted_cash": 125.50, "minimum": 124.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 200.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 200.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 200.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Compatible - x-match ahg interp", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 251.00, "discounted_cash": 125.50, "minimum": 124.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 200.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 200.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 200.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only irradiated", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 71.00, "discounted_cash": 35.50, "minimum": 8.01, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Blood product/irradiation", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 71.00, "discounted_cash": 35.50, "minimum": 8.01, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 8.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only ega treat rbc l14b", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 86.00, "minimum": 60.62, "maximum": 124.88, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 124.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 137.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Rbc pretx incubatj w/chemicl", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 86.00, "minimum": 60.62, 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Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 102.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 51.31, "methodology": "fee schedule" } ] } ] }, { "description": "Orthopoxvirus amp prb each", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 128.00, "discounted_cash": 64.00, "minimum": 51.31, "maximum": 52.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 52.34, "methodology": "fee schedule" }, { "payer_name": "Tahl 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80.0, "estimated_amount": 81.10, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hpv types 16 & 18 only", "code_information": [ { "code": "87625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.38, "discounted_cash": 50.69, "minimum": 76.52, "maximum": 76.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": 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"29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 436.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", 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"plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 436.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 436.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 436.12, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Adenovirus nhs", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1073.00, "discounted_cash": 536.50, "minimum": 76.52, "maximum": 76.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 858.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 858.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 858.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Resp virus 12-25 targets", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1073.00, "discounted_cash": 536.50, "minimum": 76.52, "maximum": 76.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 858.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 858.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 858.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Respiratory syncytial virus", "code_information": [ { "code": "87634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 175.00, "discounted_cash": 87.50, "minimum": 76.52, "maximum": 76.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rsv dna/rna amp probe", "code_information": [ { "code": "87634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 175.00, "discounted_cash": 87.50, "minimum": 76.52, "maximum": 76.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 140.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sars-cov-2 by pcr rml", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 51.31, "maximum": 52.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 52.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 52.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 51.31, "methodology": "fee schedule" } ] } ] }, { "description": "Sars-cov-2 covid-19 amp prb", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 51.31, "maximum": 52.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 52.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 52.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 51.31, "methodology": "fee schedule" } ] } ] }, { "description": "Sars-cov-2 (covid-19) rna (id now)", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 51.31, "maximum": 52.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 51.31, "methodology": "fee schedule", "modifiers": "QW" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 52.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 52.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 51.31, "methodology": "fee schedule" }, { 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Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 41.38, "methodology": "fee schedule" } ] } ] }, { "description": "Sars-cov-2 covid19 w/optic", "code_information": [ { "code": "87811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 22.50, "minimum": 41.38, "maximum": 42.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 41.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 42.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 42.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 41.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 41.38, 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"plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 15.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hiv-1 resistance proviral dna qst", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 325.86, "discounted_cash": 162.93, "minimum": 76.52, "maximum": 76.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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"payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 644.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 644.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 644.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hepatitis c genotype qst", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 805.00, "discounted_cash": 402.50, "minimum": 76.52, "maximum": 76.52, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 76.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 644.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 644.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 644.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "87906 hiv-1 resistance proviral dna qst", "code_information": [ { "code": "87906", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.83, "discounted_cash": 160.92, "minimum": 39.12, "maximum": 39.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 39.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 257.46, 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billed charges" } ] } ] }, { "description": "88104- cytology exam/non-gyn", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 21.50, "minimum": 40.06, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath fl nongyn smears", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 21.50, "minimum": 40.06, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopath no cerv/vag; smears w/int", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 41.50, "minimum": 40.06, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 66.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath fl nongyn filter", "code_information": [ { "code": "88106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 24.99, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopath fl nongyn filter", "code_information": [ { "code": "88106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 180.00, "discounted_cash": 90.00, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "88108-cytopathology concentration smear", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 37.00, "discounted_cash": 18.50, "minimum": 40.06, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 29.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 29.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 29.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath concentrate tech", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 37.00, "discounted_cash": 18.50, "minimum": 40.06, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 29.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 29.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 29.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopath concentra-smears & interp", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 52.00, "discounted_cash": 26.00, "minimum": 40.06, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 41.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "88112-non gyn cyto prep", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "minimum": 54.53, "maximum": 118.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath cell enhance tech", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "minimum": 54.53, "maximum": 118.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopath selective cell. enh. tech w/ intrp", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 60.00, "minimum": 54.53, "maximum": 55.62, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 96.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 96.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 96.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Cytp urne 3-5 probes ea spec", "code_information": [ { "code": "88120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1608.00, "discounted_cash": 804.00, "minimum": 118.20, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopathology in-situ hybrid (ex: fish)", "code_information": [ { "code": "88120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1608.00, "discounted_cash": 804.00, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Cytp urine 3-5 probes cmptr", "code_information": [ { "code": "88121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1405.00, "discounted_cash": 702.50, "minimum": 118.20, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopathology in-situ hybridization (eg fish)", "code_information": [ { "code": "88121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1405.00, "discounted_cash": 702.50, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1124.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath c/v interpret", "code_information": [ { "code": "88141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 16.50, "minimum": 41.70, "maximum": 41.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 26.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 26.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 26.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Surepath pap qst", "code_information": [ { "code": "88141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 16.50, "minimum": 41.70, "maximum": 41.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 26.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 26.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 26.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cytopath c/v thin layer", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "minimum": 41.70, "maximum": 41.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Thinprep pap qst", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "minimum": 41.70, "maximum": 41.70, "setting": "both", "payers_information": [ { 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Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "88160-cytology smear other source", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 73.00, "discounted_cash": 36.50, "minimum": 24.99, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath smear other source", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 73.00, "discounted_cash": 36.50, "minimum": 24.99, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytpath smears; screen & intrpt", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 127.00, "discounted_cash": 63.50, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 101.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 101.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 101.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "88161-cytopath prep", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 47.00, "minimum": 24.99, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": 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"Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 75.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 75.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 75.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath smear other source", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 47.00, "minimum": 24.99, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 75.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 75.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 75.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopath smear; prep/screen/interp", "code_information": [ { "code": "88161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 109.00, "discounted_cash": 54.50, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 87.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 87.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 87.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "88172-fine needle evaluation", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 28.50, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 45.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 45.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 45.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Cytp dx eval fna 1st ea site", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 28.50, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 45.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 45.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 45.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytopathologyeval fna;imm cyto study", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 28.00, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 44.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 44.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 44.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Cytopath eval fna report", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 225.00, "discounted_cash": 112.50, "minimum": 54.53, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, 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"standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only eval fine needl aspirat;intrpt/rep", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 225.00, "discounted_cash": 112.50, "minimum": 54.53, "maximum": 55.62, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 180.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "88175-pap hpv-ascus asc-h agus or lsil rml", "code_information": [ { "code": "88175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 46.50, "minimum": 41.70, "maximum": 41.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cytopath c/v auto fluid redo", "code_information": [ { "code": "88175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 46.50, "minimum": 41.70, "maximum": 41.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 41.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "88177-fna adequacy", "code_information": [ { "code": "88177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 8.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 13.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cytp fna eval ea addl", "code_information": [ { "code": "88177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 8.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 13.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Flowcytometry/ tc 1 marker", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 458.00, "discounted_cash": 229.00, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Pnh with flaer qst", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 458.00, "discounted_cash": 229.00, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "88185", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 118.20, "maximum": 118.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Flowcytometry/tc add-on", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 118.20, "maximum": 118.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": 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80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, 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"standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only surgical pathology level i", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 15.00, "minimum": 24.99, "maximum": 25.49, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "88302-ap surg path lvl ii", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 24.50, "minimum": 40.06, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 24.50, "minimum": 40.06, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only surgical pathology level ii", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 71.00, "discounted_cash": 35.50, "minimum": 40.06, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 56.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 114.00, "discounted_cash": 57.00, "minimum": 54.53, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 91.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 91.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 91.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "88304-ap surg path lvl iii-", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 114.00, "discounted_cash": 57.00, "minimum": 54.53, "maximum": 55.62, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 91.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 91.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 91.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 95.00, "discounted_cash": 47.50, "minimum": 54.53, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only surgical pathology level iv", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 95.00, "discounted_cash": 47.50, "minimum": 54.53, "maximum": 55.62, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "88307-ap surg path lvl v", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 773.00, "discounted_cash": 386.50, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 773.00, "discounted_cash": 386.50, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only surgical pathology level v", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 624.00, "discounted_cash": 312.00, "minimum": 367.10, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 499.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 499.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 499.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "88309-ap surg path lvl vi", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 118.20, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 696.00, "discounted_cash": 348.00, "minimum": 118.20, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 556.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only surgical pathology level vi", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 886.00, "discounted_cash": 443.00, "minimum": 833.67, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 708.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 708.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 708.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "88311-ap decal of tissue", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 27.00, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Decalcify tissue", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 27.00, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bill only decalcification proc - tc only", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 19.20, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "88312-special stains group i microorganisms", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 45.50, "minimum": 54.53, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Special stains group 1", "code_information": [ { "code": "88312", "type": "CPT" } ], 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"standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only special stains; grp i", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 196.00, "discounted_cash": 98.00, "minimum": 54.53, "maximum": 55.62, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 156.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 156.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 156.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Special stains group 2", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 157.00, "discounted_cash": 78.50, "minimum": 63.26, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 125.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 125.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 125.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only spec stains; group ii", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 157.00, "discounted_cash": 78.50, "minimum": 131.55, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 125.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 125.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 125.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "88314-special stains group iii frozen tx", "code_information": [ { "code": "88314", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Histochemical stains add-on", "code_information": [ { "code": "88314", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bill only spec stain; histochem stain w/froz sect int/rep", "code_information": [ { "code": "88314", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 151.00, "discounted_cash": 75.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 120.80, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 120.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 120.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "88319-special stains enzyme constituents", "code_information": [ { "code": "88319", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 503.00, "discounted_cash": 251.50, "minimum": 118.20, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 402.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 402.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 402.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Enzyme histochemistry", "code_information": [ { "code": "88319", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 503.00, "discounted_cash": 251.50, "minimum": 118.20, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 402.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 402.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 402.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Microslide consultation", "code_information": [ { "code": "88323", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.00, "discounted_cash": 70.50, "minimum": 54.53, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 55.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 112.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 112.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 112.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 54.53, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 54.53, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cons & reprt ref mat req prep slid", "code_information": [ { "code": "88323", "type": "CPT" } ], 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"standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Path consult intraop 1 bloc", "code_information": [ { "code": "88331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 254.00, "discounted_cash": 127.00, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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"30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 203.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "88332-frozen section add'l", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.00, "discounted_cash": 64.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Path consult intraop addl", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.00, "discounted_cash": 64.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "88333-touch prep with inerop call", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "minimum": 63.26, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Intraop cyto path consult 1", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "minimum": 63.26, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only cytologic examination initial site", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 99.00, "discounted_cash": 49.50, "minimum": 833.67, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 79.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 79.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 79.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "88334-touch prep add/interop call", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 19.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 31.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 31.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 31.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Intraop cyto path consult 2", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 19.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 31.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 31.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 31.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bill only cytologic examination each additional site", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 31.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Immunohisto antb addl slide", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 86.50, "minimum": 63.26, "maximum": 63.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 138.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 138.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 138.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Immunohisto antibody slide-add stain", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 86.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 138.40, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 138.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 138.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Immunohisto antb 1st stain", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "88342-immunohistochemistry stain 1st", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "88344-immunohistochemistry stain multiplex", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 244.00, "minimum": 63.26, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Immunohisto antibody slide", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 488.00, "discounted_cash": 244.00, "minimum": 63.26, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 390.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only immunohisto antibody slide", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 369.00, "discounted_cash": 184.50, "minimum": 367.10, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 295.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 295.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 295.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "88346-immunofluorescence 1st per spec", "code_information": [ { "code": "88346", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Immunofluor antb 1st stain", "code_information": [ { "code": "88346", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only immunofluor study ea antib; direct", "code_information": [ { "code": "88346", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 154.00, "discounted_cash": 77.00, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 123.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 123.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 123.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "88348-electronmicroscopy", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 118.20, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Electron microscopy", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 118.20, "maximum": 850.34, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 850.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only electron micro; dx", "code_information": [ { "code": "88348", 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"payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 143.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 143.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only morphometric analy; tumor", "code_information": [ { "code": "88358", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 55.00, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": 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manual", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 273.00, "discounted_cash": 136.50, "minimum": 118.20, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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"30770266", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 178.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 178.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 833.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 833.67, "methodology": "fee schedule" } ] } ] }, { "description": "88364-fish test interpretation ea addtl", "code_information": [ { "code": "88364", "type": "CPT" } ], 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"standard_charge_percentage": 80.0, "estimated_amount": 180.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bill only insitu hybridization fish", "code_information": [ { "code": "88364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.00, "discounted_cash": 139.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 222.40, "methodology": "percent of total billed charges", "modifiers": "TC" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 222.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 222.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "88365-fish test interpretation 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Insitu hybridization (fish)", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only tiss in situ hybridiz intrpt & rep", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 367.00, "discounted_cash": 183.50, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 293.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 293.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 293.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Insitu hybridization (fish)", "code_information": [ { "code": "88366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 550.00, "discounted_cash": 275.00, "minimum": 63.26, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 440.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 440.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 440.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only in-situ hybridization fish", "code_information": [ { "code": "88366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 550.00, "discounted_cash": 275.00, "minimum": 174.88, "maximum": 178.37, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 174.88, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 178.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 440.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 440.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 440.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 174.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 174.88, "methodology": "fee schedule" } ] } ] }, { "description": "Insitu hybridization auto", "code_information": [ { "code": "88367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Bill only morphometric analysis in situ hybridization", "code_information": [ { "code": "88367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "minimum": 367.10, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": 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"United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Insitu hybridization manual", "code_information": [ { "code": "88368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 204.00, "discounted_cash": 102.00, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 728.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 714.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 714.08, "methodology": "fee schedule" } ] } ] }, { "description": "90937 hemodialysis repeated eval charge", "code_information": [ { "code": "90937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 796.00, "discounted_cash": 398.00, "minimum": 633.29, "maximum": 1040.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 633.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 904.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 904.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 633.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 769.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1040.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hemodialysis repeated eval", "code_information": [ { "code": "90937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 796.00, "discounted_cash": 398.00, "minimum": 633.29, "maximum": 1040.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 633.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 904.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 904.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 633.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 769.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1040.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 636.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "90945 dialysis other/than hemo 1 phys/qhp eval", "code_information": [ { "code": "90945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 858.00, "discounted_cash": 429.00, "minimum": 420.97, "maximum": 691.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 511.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 691.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 686.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 686.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 686.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 434.56, "methodology": "fee schedule" } ] } ] }, { "description": "Dialysis one evaluation", "code_information": [ { "code": "90945", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 858.00, "discounted_cash": 429.00, "minimum": 420.97, "maximum": 691.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 511.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 691.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 686.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 686.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 686.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 434.56, "methodology": "fee schedule" } ] } ] }, { "description": "90947 dialysis oth/hemo repeat phy/qhp eval", "code_information": [ { "code": "90947", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 327.00, "discounted_cash": 163.50, "minimum": 420.97, "maximum": 691.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 511.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 691.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 261.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 261.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 261.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dialysis repeated eval", "code_information": [ { "code": "90947", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 327.00, "discounted_cash": 163.50, "minimum": 420.97, "maximum": 691.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 601.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 420.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 511.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 691.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 261.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 261.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 261.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "90960 esrd related services monthly 20 years and older; w/ 4 or more face to face visits", "code_information": [ { "code": "90960", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 592.00, "discounted_cash": 296.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 473.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 473.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 473.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Esrd srv 4 visits p mo 20+", "code_information": [ { "code": "90960", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 592.00, "discounted_cash": 296.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 473.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 473.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 473.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "G-esoph reflx tst w/electrod", "code_information": [ { "code": "91035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3654.91, "discounted_cash": 1827.46, "minimum": 415.14, "maximum": 552.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 415.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2923.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2923.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2923.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 541.49, "methodology": "fee schedule" } ] } ] }, { "description": "Gi tract capsule endoscopy", "code_information": [ { "code": "91110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1816.00, "discounted_cash": 908.00, "minimum": 956.80, "maximum": 6792.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4134.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5906.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5906.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4134.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5020.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6792.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 975.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 975.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1452.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1452.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1452.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 956.80, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 956.80, "methodology": "fee schedule" } ] } ] }, { "description": "91122  anorectal manometry techfee", "code_information": [ { "code": "91122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 552.00, "discounted_cash": 276.00, "minimum": 126.87, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 441.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 441.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 441.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Anal pressure record", "code_information": [ { "code": "91122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 552.00, "discounted_cash": 276.00, "minimum": 126.87, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 441.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 441.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 441.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "92235 fluorescein angioscopy interpretation & report pro fee", "code_information": [ { "code": "92235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "minimum": 95.69, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 95.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 136.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 136.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 95.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 116.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 157.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Fluorescein angrph uni/bi", "code_information": [ { "code": "92235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "minimum": 95.69, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 95.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 136.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 136.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 95.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 116.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 157.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Speech/hearing therapy", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 292.00, "discounted_cash": 146.00, "minimum": 71.37, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 71.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 72.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 72.80, 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"methodology": "percent of total billed charges" } ] } ] }, { "description": "92520 laryngeal function study", "code_information": [ { "code": "92520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 95.00, "discounted_cash": 47.50, "minimum": 10.13, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee 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Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Evaluation of speech fluency", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.00, "discounted_cash": 123.00, "minimum": 119.00, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 124.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 126.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 126.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 124.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 124.21, "methodology": "fee schedule" }, { 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"payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 124.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 124.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 124.21, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 124.21, "methodology": "fee schedule" } ] } ] }, { "description": "Slp speech fluency eval units", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 246.00, "discounted_cash": 123.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 196.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Evaluate speech production", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "minimum": 103.46, "maximum": 195.53, "setting": "both", 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"standard_charge_dollar": 105.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 105.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 103.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 103.46, "methodology": "fee schedule" } ] } ] }, { "description": "Slp sound production eval units", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 99.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 158.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Speech sound lang comprehen", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 402.00, "discounted_cash": 201.00, "minimum": 119.00, "maximum": 216.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": 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212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 212.44, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 212.44, "methodology": "fee schedule" } ] } ] }, { "description": "Slp sound prod w/ lang comp eval units", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 402.00, "discounted_cash": 201.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Behavral qualit analys voice", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "minimum": 101.75, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 103.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 103.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 101.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 101.75, "methodology": "fee schedule" } ] } ] }, { "description": "Behav/qual analysis of voice and resonance charge", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Oral function therapy", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 69.50, "minimum": 78.43, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 80.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 80.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 78.43, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 78.43, "methodology": "fee schedule" } ] } ] }, { "description": "Slp swallow dysfunction oral feed units", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 69.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 111.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pure tone hearing test air", "code_information": [ { "code": "92551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 16.00, "minimum": 82.70, "maximum": 82.70, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 82.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 82.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 82.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 82.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 82.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 82.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 25.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 25.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 25.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Slp screening test pure tone air units", "code_information": [ { "code": "92551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 16.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 25.60, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 25.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 25.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Evoked auditory test limited", "code_information": [ { "code": "92587", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 95.00, "discounted_cash": 47.50, "minimum": 10.13, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 10.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee 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Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.00, "methodology": "percent of total billed charges" }, { 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"29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 78.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 78.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 78.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Slp non-speech aac device tx units", "code_information": [ { "code": "92606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 98.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 78.40, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 78.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 78.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ex for speech device rx 1hr", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 130.00, "minimum": 114.21, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 116.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 116.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 114.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, 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"payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 208.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ex for speech device rx addl", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 17.00, "minimum": 44.78, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 45.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 45.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 44.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 44.78, "methodology": "fee schedule" } ] } ] }, { "description": "Slp speech aac eval addl half hour minutes", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 17.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Use of speech device service", "code_information": [ { "code": "92609", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 181.00, "discounted_cash": 90.50, "minimum": 95.11, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 195.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 97.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 97.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 95.11, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 95.11, "methodology": "fee schedule" } ] } ] }, { "description": "Slp speech-gen dev prog and mod", "code_information": [ { "code": "92609", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 181.00, "discounted_cash": 90.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 144.80, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 144.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 144.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dnu 97127 cognitive function interventions", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 108.00, "minimum": 65.87, "maximum": 195.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 170.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 144.51, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 65.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 65.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 65.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 65.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 65.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, 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}, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 59.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 83.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 85.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 85.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 83.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 83.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 61.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 61.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 61.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 61.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 61.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 61.42, "methodology": "fee schedule" }, { "payer_name": 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"92612", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 129.00, "discounted_cash": 64.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "92612 (fees) flexible fiberoptic endoscopic evaluation of swallowing by cine or video", "code_information": [ { "code": "92614", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 79.00, "minimum": 60.53, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5818.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5818.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 20971.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 20971.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5818.54, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5818.54, "methodology": "fee schedule" } ] } ] }, { "description": "92921 xa 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7027.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7027.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7027.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prq cardiac angio addl art", "code_information": [ { "code": "92921", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8784.00, "discounted_cash": 4392.00, "minimum": 20313.86, "maximum": 33376.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 20313.86, "methodology": "fee 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 29022.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 29022.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 20313.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 24668.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 33376.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prq card revasc chronic addl", "code_information": [ { "code": "92944", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8034.00, "discounted_cash": 4017.00, "minimum": 20313.86, "maximum": 33376.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 20313.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 29022.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 29022.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 20313.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 24668.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 33376.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "92950  cardiopulmonary resuscitation ed techfee", "code_information": 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Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Heart/lung resuscitation cpr", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 750.00, "discounted_cash": 375.00, "minimum": 317.79, "maximum": 3012.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1833.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2619.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2619.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1833.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2226.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3012.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 600.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Temporary cardiac pacemaker - procedure performed.", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 235.00, "discounted_cash": 117.50, "minimum": 859.90, "maximum": 2470.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1503.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2147.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2147.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1503.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1825.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2470.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 188.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 188.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 188.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Temporary external pacing", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 235.00, "discounted_cash": 117.50, "minimum": 859.90, "maximum": 2470.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1503.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2147.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2147.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1503.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1825.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2470.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 188.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 188.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 188.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Cardioversion electric ext", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3860.97, "discounted_cash": 1930.49, "minimum": 667.81, "maximum": 2470.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1503.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2147.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2147.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1503.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1825.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2470.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": 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"29043841", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3088.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3088.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": 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Eldercare", "plan_name": "29046164", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 23441.36, "methodology": "percent of total billed charges" } ] } ] }, { "description": "92973 pci ca mechanical thrombectomy", "code_information": [ { "code": "92973", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6427.00, "discounted_cash": 3213.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5141.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5141.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5141.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prq coronary mech thrombect", "code_information": [ { "code": "92973", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6427.00, "discounted_cash": 3213.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5141.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5141.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5141.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "92975 xa thrombolysis ic", "code_information": [ { "code": "92975", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4820.00, "discounted_cash": 2410.00, "minimum": 7022.84, "maximum": 11538.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 7022.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10033.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10033.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7022.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8528.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 11538.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dissolve clot heart vessel", "code_information": [ { "code": "92975", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4820.00, "discounted_cash": 2410.00, "minimum": 7022.84, "maximum": 11538.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 7022.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10033.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10033.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7022.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 8528.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 11538.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3856.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "92977 thrombolysis intravenous infusion ed charge", "code_information": [ { "code": "92977", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 338.50, "maximum": 11538.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 7022.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 10033.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 10033.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 7022.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": 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schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 338.50, "methodology": "fee schedule" } ] } ] }, { "description": "Dissolve clot heart vessel", "code_information": [ { "code": "92977", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 338.50, 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Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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32298.31, "discounted_cash": 16149.16, "minimum": 5818.54, "maximum": 33376.45, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 20313.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 29022.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 29022.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 20313.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 24668.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 33376.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 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"plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", 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"plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Cardiovascular stress test", "code_information": [ { "code": "93017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 119.18, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Ett nm treadmill stress test", "code_information": [ { "code": "93017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 927.00, "discounted_cash": 463.50, "minimum": 119.18, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 119.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 741.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "93040  rhythm ecg 1-3 leads w/interpretation & report techfee", "code_information": [ { "code": "93040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89.00, "discounted_cash": 44.50, "minimum": 25.81, "maximum": 25.81, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 71.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 71.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 71.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rhythm ecg with report", "code_information": [ { "code": "93040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89.00, "discounted_cash": 44.50, "minimum": 25.81, "maximum": 25.81, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 71.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 71.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 71.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "93041 ekg 3 lead tracing charge", "code_information": [ { "code": "93041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 44.00, "minimum": 25.81, "maximum": 61.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Rhythm ecg tracing", "code_information": [ { "code": "93041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 44.00, "minimum": 25.81, "maximum": 61.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Ecg monit/reprt up to 48 hrs", "code_information": [ { "code": "93224", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 680.00, "discounted_cash": 340.00, "minimum": 276.50, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 544.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 544.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 544.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Holter monitor - 24hr", "code_information": [ { "code": "93224", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 680.00, "discounted_cash": 340.00, "minimum": 276.50, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 544.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 544.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 544.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ecg monit/reprt up to 48 hrs", "code_information": [ { "code": "93225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 346.00, "discounted_cash": 173.00, "minimum": 83.21, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 276.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 276.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 276.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Holter monitor 24 hrs - rt cardiology charges", "code_information": [ { "code": "93225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 346.00, "discounted_cash": 173.00, "minimum": 83.21, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 276.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 276.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 276.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "93226 electrocardiographic monitoring for 24hrs;scanning analysis with report", "code_information": [ { "code": "93226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 187.00, "discounted_cash": 93.50, "minimum": 60.62, "maximum": 83.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Ecg monit/reprt up to 48 hrs", "code_information": [ { "code": "93226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 187.00, "discounted_cash": 93.50, "minimum": 60.62, "maximum": 83.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 149.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "93241- ext ecg>48hr<7d rec scan a/r", "code_information": [ { "code": "93241", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Xtrnl ecg rec>48hr<7d", "code_information": [ { "code": "93241", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" } ] } ] }, { "description": "93242- ext ecg>48hr<7d recording", "code_information": [ { "code": "93242", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 45.50, "minimum": 40.06, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "Ext ecg>48hr<7d recording", "code_information": [ { "code": "93242", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 45.50, "minimum": 40.06, "maximum": 40.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 72.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.06, "methodology": "fee schedule" } ] } ] }, { "description": "93243- ext ecg>48hr<7d scan a/r", "code_information": [ { "code": "93243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 298.00, "discounted_cash": 149.00, "minimum": 131.55, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 238.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 238.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 238.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Ext ecg>48hr<7d scan a/r", "code_information": [ { "code": "93243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 298.00, "discounted_cash": 149.00, "minimum": 131.55, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 238.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 238.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 238.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "93244- ext ecg>48hr<7d review & interpret", "code_information": [ { "code": "93244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ext ecg>48hr<7d rev&interpj", "code_information": [ { "code": "93244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 0.01, "methodology": "percent of total billed charges" } ] } ] }, { "description": "93268 external patient and when performed auto activated electrocardiographic rhythm up to 30 days", "code_information": [ { "code": "93268", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "minimum": 276.50, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ecg record/review", "code_information": [ { "code": "93268", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "minimum": 276.50, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "93270 emergency ecg ambulance charge", "code_information": [ { "code": "93270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 38.06, "maximum": 83.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "Remote 30 day ecg rev/report", "code_information": [ { "code": "93270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 38.06, "maximum": 83.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 83.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "93271 external patient and when performed auto activated electrocardiographic rhythm transmission", "code_information": [ { "code": "93271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 230.00, "discounted_cash": 115.00, "minimum": 93.67, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 95.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 95.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 184.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 184.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 184.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 93.67, "methodology": "fee schedule" } ] } ] }, { "description": "Ecg/monitoring and analysis", "code_information": [ { "code": "93271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 230.00, "discounted_cash": 115.00, "minimum": 93.67, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 95.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 95.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 184.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 184.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 184.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 93.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 93.67, "methodology": "fee schedule" } ] } ] }, { "description": "Prgrmg dev eval pm/ldls pm", "code_information": [ { "code": "93279", "type": "CPT" } ], "standard_charges": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 432.80, "methodology": "percent of 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"standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "Pm device progr eval multi", "code_information": [ { "code": "93281", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 618.00, "discounted_cash": 309.00, "minimum": 38.06, "maximum": 73.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "Prgrmg eval implantable dfb", "code_information": [ { "code": "93282", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 659.00, "discounted_cash": 329.50, "minimum": 38.06, "maximum": 73.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 527.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 527.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 527.20, "methodology": "percent of total billed charges" }, { "payer_name": 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"standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 576.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 576.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 576.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "Prgrmg eval implantable dfb", "code_information": [ { "code": "93284", "type": "CPT" } ], 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"standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "Interrog evl pm/ldls pm ip", "code_information": [ { "code": "93288", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 541.00, "discounted_cash": 270.50, "minimum": 38.06, "maximum": 73.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 73.87, "methodology": 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"standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 432.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 432.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "Interrog device eval heart", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 618.00, "discounted_cash": 309.00, "minimum": 38.06, "maximum": 73.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 38.06, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 38.06, "methodology": "fee schedule" } ] } ] }, { "description": "Implantalbe loop recorder", "code_information": [ { "code": "93291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 618.00, "discounted_cash": 309.00, "minimum": 24.99, "maximum": 73.87, "setting": "both", "payers_information": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Interrog dev eval scrms ip", "code_information": [ { "code": "93291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 618.00, "discounted_cash": 309.00, "minimum": 24.99, "maximum": 73.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 73.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 494.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.99, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.99, "methodology": "fee schedule" } ] } ] }, { "description": "Echo transthoracic", "code_information": [ { "code": "93303", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transthoracic echocardio w/o contrast", "code_information": [ { "code": "93303", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo transthoracic", "code_information": [ { "code": "93304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transthoracic echocardio w/o contra", "code_information": [ { "code": "93304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Tte w/doppler complete", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3949.55, "discounted_cash": 1974.78, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3159.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3159.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3159.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Tte w/o doppler complete", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1103.00, "discounted_cash": 551.50, "minimum": 246.68, "maximum": 496.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 882.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Tte f-up or lmtd", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4440.67, "discounted_cash": 2220.34, "minimum": 246.68, "maximum": 496.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3552.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3552.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3552.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Echo transesophageal", "code_information": [ { "code": "93312", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3402.29, "discounted_cash": 1701.15, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2721.83, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2721.83, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2721.83, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo transesophageal", "code_information": [ { "code": "93315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transesophageal w/o contrast", "code_information": [ { "code": "93315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo transesophageal intraop", "code_information": [ { "code": "93318", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transesophageal w/ out contrast", "code_information": [ { "code": "93318", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Doppler echo exam heart", "code_information": [ { "code": "93320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2567.07, "discounted_cash": 1283.54, "minimum": 496.02, "maximum": 496.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2053.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2053.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2053.66, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Doppler color flow add-on", "code_information": [ { "code": "93325", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2567.07, "discounted_cash": 1283.54, "minimum": 496.02, "maximum": 496.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2053.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2053.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2053.66, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Stress tte only", "code_information": [ { "code": "93350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2477.14, "discounted_cash": 1238.57, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 570.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1981.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1981.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1981.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transthoracic echo w/o color flow", "code_information": [ { "code": "93351", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 570.74, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", 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"standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 559.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 559.55, "methodology": "fee schedule" } ] } ] }, { "description": "Right heart cath", "code_information": [ { "code": "93451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9655.94, "discounted_cash": 4827.97, "minimum": 2314.44, "maximum": 3348.07, "setting": "both", "payers_information": [ { 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3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7724.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7724.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7724.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" } ] } ] }, { "description": "Left heart cath", "code_information": [ { "code": "93452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5842.00, "discounted_cash": 2921.00, "minimum": 2314.44, "maximum": 3348.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4673.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4673.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4673.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" } ] } ] }, { "description": "Left hrt cath w/ventrclgrphy", "code_information": [ { "code": "93452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5842.00, "discounted_cash": 2921.00, "minimum": 2314.44, "maximum": 3348.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4673.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4673.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4673.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" } ] } ] }, { "description": "93453  r & l hrt cath w/njx l ventriculog img s&i techfee", "code_information": [ { "code": "93453", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6695.00, "discounted_cash": 3347.50, "minimum": 2314.44, "maximum": 3348.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2314.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 3348.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5356.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 3282.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5356.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1628.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1585.32, "methodology": "fee schedule" } ] } ] }, { "description": "93566 xa rv angiography", "code_information": [ { "code": "93566", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2142.00, "discounted_cash": 1071.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1713.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1713.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1713.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Inject r ventr/atrial angio", "code_information": [ { "code": "93566", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2142.00, "discounted_cash": 1071.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1713.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1713.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1713.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Inject suprvlv aortography", "code_information": [ { "code": "93567", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15576.01, "discounted_cash": 7788.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12460.81, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12460.81, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12460.81, "methodology": "percent of total billed charges" } ] } ] }, { "description": "93568  njx pulmonary angio hrt cath w/s&i techfee", "code_information": [ { "code": "93568", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 747.00, "discounted_cash": 373.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 597.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 597.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 597.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Inject pulm art hrt cath", "code_information": [ { "code": "93568", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 747.00, "discounted_cash": 373.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 597.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 597.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 597.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Heart flow reserve measure", "code_information": [ { "code": "93571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15212.01, "discounted_cash": 7606.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12169.61, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12169.61, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12169.61, "methodology": "percent of total billed charges" } ] } ] }, { "description": "93572 xa fr coronary ea add'l vessel", "code_information": [ { "code": "93572", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "minimum": 496.02, "maximum": 496.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Heart flow reserve measure", 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276.50, "maximum": 552.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 541.49, "methodology": "fee schedule" } ] } ] }, { "description": "93668 pad supervised exercise therapy- kx charge", "code_information": [ { "code": "93668", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.00, "discounted_cash": 66.00, "minimum": 56.61, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 105.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 105.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 105.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "Peripheral vascular rehab", "code_information": [ { "code": "93668", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 132.00, "discounted_cash": 66.00, "minimum": 56.61, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 105.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 105.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 105.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": "fee schedule" } ] } ] }, { "description": "93798 -cr w/cont ecg monitor", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 163.00, "discounted_cash": 81.50, "minimum": 111.95, "maximum": 183.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 111.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 159.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 159.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 111.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 135.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 183.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 131.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 131.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 128.49, "methodology": "fee schedule" } ] } ] }, { "description": "Cardiac rehab/monitor", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 163.00, "discounted_cash": 81.50, "minimum": 111.95, "maximum": 183.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 111.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 159.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 159.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 111.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 135.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 183.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 131.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 131.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 130.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 128.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 128.49, "methodology": "fee schedule" } ] } ] }, { "description": "93880 carotid artery duplex charge", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1545.00, "discounted_cash": 772.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Extracranial bilat study", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1545.00, "discounted_cash": 772.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "93882 extracranial study", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 516.00, "discounted_cash": 258.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 412.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 412.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 412.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Extracranial uni/ltd study", "code_information": [ { "code": "93882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 516.00, 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charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 412.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl 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Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 868.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 868.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Upr/l xtremity art 2 levels", "code_information": [ { "code": "93922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1086.00, "discounted_cash": 543.00, "minimum": 131.55, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 868.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": 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"29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 156.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", 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"standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 156.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 156.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 156.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, 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"29030835", "standard_charge_dollar": 276.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Us le doppler w/ stress test", "code_information": [ { "code": "93924", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 389.00, "discounted_cash": 194.50, "minimum": 159.67, "maximum": 276.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 311.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "93925 lwr ext artery duplex-bi charge", "code_information": [ { "code": "93925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1185.00, "discounted_cash": 592.50, "minimum": 246.68, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Lower extremity study", "code_information": [ { "code": "93925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1185.00, "discounted_cash": 592.50, "minimum": 246.68, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "93926 duplex lower extremity areteries/bypass grafts; unilateral or limited poc", "code_information": [ { "code": "93926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 993.00, "discounted_cash": 496.50, "minimum": 108.52, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 794.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 794.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 794.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Lower extremity study", "code_information": [ { "code": "93926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 993.00, "discounted_cash": 496.50, "minimum": 108.52, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 794.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 794.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 794.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Upper extremity study", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.00, "discounted_cash": 166.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Us ue arterial duplex bilateral", "code_information": [ { "code": "93930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 333.00, "discounted_cash": 166.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 266.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Upper extremity study", "code_information": [ { "code": "93931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 118.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us wrist/arm unilateral", "code_information": [ { "code": "93931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 118.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 189.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "93970  dup-scan xtr veins complete bilateral study techfee", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1185.00, "discounted_cash": 592.50, "minimum": 246.68, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Extremity study", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1185.00, "discounted_cash": 592.50, "minimum": 246.68, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 948.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "93971 venous duplex uni charge", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 990.00, "discounted_cash": 495.00, "minimum": 108.52, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Extremity study", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 990.00, "discounted_cash": 495.00, "minimum": 108.52, "maximum": 346.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 346.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", 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"30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us ue venous duplex left dup-scan xtr veins unilateral/limited study", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 990.00, "discounted_cash": 495.00, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "LT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us ue venous duplex right dup-scan xtr veins unilateral/limited study", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 990.00, "discounted_cash": 495.00, "minimum": 108.52, "maximum": 110.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule", "modifiers": "RT" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 792.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "93975 art duplex abdomen/renal charge", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 549.00, "discounted_cash": 274.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 439.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 439.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 439.20, "methodology": "percent of total 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"plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 439.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 439.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 439.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "93976 renal doppler limited charge", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 358.00, "discounted_cash": 179.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Vascular study", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 358.00, "discounted_cash": 179.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 286.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "93978 dup-scan aorta ivc iliac vascl/bpgs complete", "code_information": [ { "code": "93978", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 515.00, "discounted_cash": 257.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Vascular study", "code_information": [ { "code": "93978", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 515.00, "discounted_cash": 257.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 412.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "93980  dup-scan artl infl&ven o/f pen vsl compl techfee", "code_information": [ { "code": "93980", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 270.00, "discounted_cash": 135.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 216.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 216.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 216.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Penile vascular study", "code_information": [ { "code": "93980", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 270.00, "discounted_cash": 135.00, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 216.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 216.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 216.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Dup-scan hemo compl bi std", "code_information": [ { "code": "93985", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 289.00, "discounted_cash": 144.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 231.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 231.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 231.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Us vessel mapping for dialysis", "code_information": [ { "code": "93985", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 289.00, "discounted_cash": 144.50, "minimum": 208.65, "maximum": 251.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 251.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 231.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 231.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 231.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 246.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 246.68, "methodology": "fee schedule" } ] } ] }, { "description": "Doppler flow testing", "code_information": [ { "code": "93990", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 279.00, "discounted_cash": 139.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 223.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 223.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 223.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Us duplex hemodialysis access flow", "code_information": [ { "code": "93990", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 279.00, "discounted_cash": 139.50, "minimum": 108.52, "maximum": 208.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 208.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 110.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 223.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 223.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 223.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 108.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 108.52, "methodology": "fee schedule" } ] } ] }, { "description": "Vent mgmt inpat init day", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 249.50, "minimum": 329.13, "maximum": 877.10, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 399.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 540.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Ventilator services initial", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 249.50, "minimum": 329.13, "maximum": 877.10, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 399.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 540.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Rt ventilator services - subs charge", "code_information": [ { "code": "94003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 249.50, "minimum": 329.13, "maximum": 877.10, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 399.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 540.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Vent mgmt inpat subq day", "code_information": [ { "code": "94003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 249.50, "minimum": 329.13, "maximum": 877.10, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 399.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 540.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 399.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Vent mgmt nf per day", "code_information": [ { "code": "94004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4605.34, "discounted_cash": 2302.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3684.27, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3684.27, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3684.27, "methodology": "percent of total billed charges" } ] } ] }, { "description": "94010 pulmonary function test", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.00, "discounted_cash": 161.00, "minimum": 128.35, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, 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Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Breathing capacity test", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.00, "discounted_cash": 161.00, "minimum": 128.35, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 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Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 407.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 407.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 407.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Aerosol initial", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 493.00, "discounted_cash": 246.50, "minimum": 207.56, "maximum": 984.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", 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"plan_name": "29045832", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 394.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 394.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 394.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 207.56, "methodology": "fee schedule" } ] } ] }, { "description": "Aerosol subsequent", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 493.00, "discounted_cash": 246.50, "minimum": 207.56, "maximum": 211.72, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 207.56, "methodology": "fee schedule", "modifiers": "76" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 394.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 394.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 394.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 207.56, "methodology": "fee schedule" } ] } ] }, { "description": "Cbt 1st hour", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 55.50, "minimum": 128.35, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Rt continuous neb initial charge", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 55.50, "minimum": 128.35, "maximum": 134.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "94645  continuous inhalation treatment ea addl hr techfee", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.00, "discounted_cash": 50.50, "minimum": 128.35, "maximum": 128.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cbt each addl hour", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.00, "discounted_cash": 50.50, "minimum": 128.35, "maximum": 128.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Bipap/cpap initial", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 207.56, "maximum": 540.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 399.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 540.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 207.56, "methodology": "fee schedule" } ] } ] }, { "description": "Pos airway pressure cpap", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 154.00, "minimum": 207.56, "maximum": 540.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 470.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 329.13, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 399.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 540.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 246.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 207.56, "methodology": "fee schedule" } ] } ] }, { "description": "Aerosol equipment instruction", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 83.00, "minimum": 163.16, "maximum": 211.72, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 163.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 163.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 163.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 163.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 163.16, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 211.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 132.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 207.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 132.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 132.80, "methodology": "percent of total billed charges" }, { 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"plan_name": "29030808", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 727.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 984.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee 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}, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Chest wall manipulation", "code_information": [ { "code": "94667", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 48.00, "minimum": 131.55, "maximum": 984.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 727.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 984.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, 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"29030731", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 727.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 984.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Cpt subsequent", "code_information": [ { "code": "94668", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 39.00, "minimum": 131.55, "maximum": 984.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 856.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 599.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 727.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 984.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Pulm funct tst plethysmograp", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 593.00, "discounted_cash": 296.50, "minimum": 128.35, 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Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Pulm function test by gas", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.00, "discounted_cash": 167.00, "minimum": 128.35, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 267.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 267.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 267.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Rt lung volumes charge", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.00, "discounted_cash": 167.00, "minimum": 128.35, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 267.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 267.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 267.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Airwy resist by oscillometry", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 593.00, "discounted_cash": 296.50, "minimum": 128.35, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Rt airway resistance charge", "code_information": [ { "code": "94728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 593.00, "discounted_cash": 296.50, "minimum": 128.35, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 474.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Co/membane diffuse capacity", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 42.00, "minimum": 128.35, "maximum": 128.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 67.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 67.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 67.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rt diffusion capacity weaning charge", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 84.00, "discounted_cash": 42.00, "minimum": 128.35, "maximum": 128.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Measure blood oxygen level", "code_information": [ { "code": "94762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 458.00, "discounted_cash": 229.00, "minimum": 859.90, "maximum": 877.10, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", 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"standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 366.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "Incentive spirometry initial", "code_information": [ { "code": "94799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 23.00, "minimum": 128.35, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 128.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 128.35, 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Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": 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"standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "95700 eeg continuous recording w. video when performed setup education takedown min 8 channels", "code_information": [ { "code": "95700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 344.00, "discounted_cash": 172.00, "minimum": 159.67, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 275.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 275.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 275.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg cont rec w/vid eeg tech", "code_information": [ { "code": "95700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 344.00, "discounted_cash": 172.00, "minimum": 159.67, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 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schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg w/o vid 2-12hr cont mntr", "code_information": [ { "code": "95707", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 346.00, "minimum": 317.79, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 541.49, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg wo vid ea 12-26hr unmntr", "code_information": [ { "code": "95708", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1181.00, "discounted_cash": 590.50, "minimum": 541.49, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 541.49, "methodology": "fee schedule" } ] } ] }, { "description": "95709 - electroencephalogram (eeg) without video review of data technical description by eeg tech", "code_information": [ { "code": "95709", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1181.00, "discounted_cash": 590.50, "minimum": 541.49, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 541.49, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg w/o vid ea 12-26hr intmt", "code_information": [ { "code": "95709", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1181.00, "discounted_cash": 590.50, "minimum": 541.49, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 541.49, "methodology": "fee schedule" } ] } ] }, { "description": "95710 - electroencephalogram (eeg) without video review of data technical description by eeg tech", "code_information": [ { "code": "95710", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1181.00, "discounted_cash": 590.50, "minimum": 541.49, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 944.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 541.49, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg w/o vid ea 12-26hr cont", "code_information": [ { "code": "95710", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1181.00, "discounted_cash": 590.50, "minimum": 541.49, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4660.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4660.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" } ] } ] }, { "description": "Polysom <6 yrs cpap/bilvl", "code_information": [ { "code": "95783", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5826.00, "discounted_cash": 2913.00, "minimum": 1038.27, "maximum": 1586.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1586.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1586.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1586.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1586.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1586.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1586.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": 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] }, { "description": "95810 polysomnography charge", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5826.00, "discounted_cash": 2913.00, "minimum": 1038.27, "maximum": 1059.04, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1038.27, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1059.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1059.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", 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"plan_name": "30770266", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4660.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4660.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" } ] } ] }, { "description": "Polysom 6/>yrs cpap 4/> parm", "code_information": [ { "code": "95811", "type": "CPT" 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80.0, "estimated_amount": 5085.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5085.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5085.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" } ] } ] }, { "description": "95811 polysomnography w/ cpap charge", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6357.00, "discounted_cash": 3178.50, "minimum": 1038.27, "maximum": 1059.04, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1038.27, "methodology": "fee schedule", "modifiers": "TC" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1059.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1059.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5085.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5085.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5085.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1038.27, "methodology": "fee schedule" } ] } ] }, { "description": "95812 cont eeg monitoring w/o video 41-60 min", "code_information": [ { "code": "95812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 346.00, "minimum": 317.79, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg 41-60 minutes", "code_information": [ { "code": "95812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 346.00, "minimum": 317.79, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "95813 cont eeg monitoring w/o video 61-119 min", "code_information": [ { "code": "95813", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 346.00, "minimum": 317.79, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg extnd mntr 61-119 min", "code_information": [ { "code": "95813", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 346.00, "minimum": 317.79, "maximum": 3290.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2861.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2002.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2431.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3290.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "95816  electroencephalogram w/rec awake&drowsy techfee", "code_information": [ { "code": "95816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 472.00, "discounted_cash": 236.00, "minimum": 317.79, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 377.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 377.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 377.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg awake and drowsy", "code_information": [ { "code": "95816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 472.00, "discounted_cash": 236.00, "minimum": 317.79, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 377.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 377.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 377.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "95819 electroencephalogram (eeg); including recording awake and asleep 20-40 minutes", "code_information": [ { "code": "95819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 346.00, "minimum": 317.79, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg awake and asleep", "code_information": [ { "code": "95819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 346.00, "minimum": 317.79, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 553.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "95822 electroencephalogram (eeg); recording in coma or sleep only", "code_information": [ { "code": "95822", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 720.00, "discounted_cash": 360.00, "minimum": 317.79, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 576.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 576.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 576.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Eeg coma or sleep only", "code_information": [ { "code": "95822", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 720.00, "discounted_cash": 360.00, "minimum": 317.79, "maximum": 1058.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1058.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 576.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 576.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 576.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Emg (ndl) 4 ext - rt nerve conduction study (emg) charges", "code_information": [ { "code": "95885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 935.00, "discounted_cash": 467.50, "minimum": 181.43, "maximum": 181.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 748.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 748.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 748.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Musc tst done w/nerv tst lim", "code_information": [ { "code": "95885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 935.00, "discounted_cash": 467.50, "minimum": 181.43, "maximum": 181.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 748.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 748.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 748.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Emg ea extremity 5+", "code_information": [ { "code": "95886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 394.00, "discounted_cash": 197.00, "minimum": 181.43, "maximum": 181.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Musc test done w/n test comp", "code_information": [ { "code": "95886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 394.00, "discounted_cash": 197.00, "minimum": 181.43, "maximum": 181.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 315.20, 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"standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Nvr cndj tst 1-2 studies", "code_information": [ { "code": "95907", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 390.00, "discounted_cash": 195.00, "minimum": 159.67, "maximum": 181.43, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 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"fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "3-4 studies - rt nerve conduction studies (emg) charges", "code_information": [ { "code": "95908", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 390.00, "discounted_cash": 195.00, "minimum": 181.43, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": 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"Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 312.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "95909 nerve velocity 5 to 6", "code_information": [ { "code": "95909", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 603.00, "discounted_cash": 301.50, "minimum": 181.43, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 324.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 482.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 482.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 482.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 317.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 317.79, "methodology": "fee schedule" } ] } ] }, { "description": "Nrv cndj tst 5-6 studies", "code_information": [ { "code": "95909", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 603.00, "discounted_cash": 301.50, "minimum": 181.43, "maximum": 324.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { 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] } ] }, { "description": "13 or greater studies - rt nerve conduction studies (emg) charges", "code_information": [ { "code": "95913", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 612.00, "discounted_cash": 306.00, "minimum": 181.43, "maximum": 552.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 181.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 552.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 489.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 541.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 541.49, "methodology": "fee 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"29043841", "standard_charge_dollar": 33.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 33.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 33.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 33.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 33.12, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 33.12, "methodology": "fee schedule" } ] } ] }, { "description": "Pt canalith repositioning assistant units", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges", "modifiers": "CQ" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot canalith repositioning units", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Canalith repositioning procedure units", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Assessment of aphasia", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.00, "discounted_cash": 76.00, "minimum": 89.60, "maximum": 91.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.60, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 121.60, "methodology": "percent of total billed charges" }, { 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"plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 121.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.60, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.60, "methodology": "fee schedule" } ] } ] }, { "description": "Slp assessment of aphasia units", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 152.00, "discounted_cash": 76.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 121.60, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 121.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 121.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Cognitive test by hc pro", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 75.00, "minimum": 94.64, "maximum": 96.53, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 96.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 96.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 94.64, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 94.64, "methodology": "fee schedule" } ] } ] }, { "description": "Slp cognitive test units", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 75.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Psycl/nrpsyc tst phy/qhp ea", "code_information": [ { "code": "96137", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 53.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 84.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 84.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 84.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "96137 telehealth psycl/nrpsyc tst phy/qhp ea", "code_information": [ { "code": "96137", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 106.00, "discounted_cash": 53.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 84.80, "methodology": "percent of total billed charges", "modifiers": "95" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 84.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 84.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "96360 - hydration first hour- hosp", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 204.00, "discounted_cash": 102.00, "minimum": 180.15, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 215.01, "methodology": "fee schedule" } ] } ] }, { "description": "Hydration iv infusion init", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 204.00, "discounted_cash": 102.00, "minimum": 180.15, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 215.01, "methodology": "fee schedule" } ] } ] }, { "description": "96361 iv hydration ea addl hr charge", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 47.09, "maximum": 146.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydrate iv infusion add-on", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 47.09, "maximum": 146.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "96365 iv infusion therapy 1st hour charge inf", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 180.15, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 215.01, "methodology": "fee schedule" } ] } ] }, { "description": "Ther/proph/diag iv inf init", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 180.15, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 215.01, "methodology": "fee schedule" } ] } ] }, { "description": "96366 iv infusion ea addl hr charge", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 47.09, "maximum": 146.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "Ther/proph/diag iv inf addon", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 47.09, "maximum": 146.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous 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"29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "96367 iv infusion ther proph addl sequential to 1 hr", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 72.63, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "Tx/proph/dg addl seq iv inf", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "minimum": 72.63, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "96368 concurrent infusion", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 107.00, "discounted_cash": 53.50, "minimum": 180.15, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ther/diag concurrent inf", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 107.00, "discounted_cash": 53.50, "minimum": 180.15, "maximum": 295.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ther/proph/diag inj sc/im", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3512.80, "discounted_cash": 1756.40, "minimum": 72.63, "maximum": 74.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2810.24, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2810.24, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2810.24, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "96374 - iv push single or initial- hosp", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 215.01, "maximum": 219.31, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 215.01, "methodology": "fee schedule" } ] } ] }, { "description": "Ther/proph/diag inj iv push", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 258.00, "discounted_cash": 129.00, "minimum": 215.01, "maximum": 219.31, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 219.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 206.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 215.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 215.01, "methodology": "fee schedule" } ] } ] }, { "description": "96375 - iv injection each additional new drug- hosp", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 74.00, "minimum": 47.09, "maximum": 48.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 118.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 118.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 118.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "Tx/pro/dx inj new drug addon", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 74.00, "minimum": 47.09, "maximum": 48.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 118.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 118.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 118.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "96376 - iv injection add same drug 31 min later- hosp", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 38.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 61.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 61.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 61.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tx/pro/dx inj same drug adon", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 38.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 61.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 61.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 61.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "96401 chemo adm im non hormonal charge", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 72.63, "maximum": 74.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "Chemo anti-neopl sq/im", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 96.50, "minimum": 72.63, "maximum": 74.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 154.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "96402 chemotherapy administration subcutaneous or im; hormonal anti-neoplastic", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 143.00, "discounted_cash": 71.50, "minimum": 72.63, "maximum": 74.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 114.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 114.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 114.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "Chemo hormon antineopl sq/im", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 143.00, "discounted_cash": 71.50, "minimum": 72.63, "maximum": 74.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 114.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 114.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 114.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "96409 chemo iv push initial charge", "code_information": [ { "code": "96409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 338.50, "maximum": 345.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 338.50, "methodology": "fee schedule" } ] } ] }, { "description": "Chemo iv push sngl drug", "code_information": [ { "code": "96409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 321.00, "discounted_cash": 160.50, "minimum": 338.50, "maximum": 345.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 256.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 338.50, "methodology": "fee schedule" } ] } ] }, { "description": "96411 chemo iv push addl charge", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "minimum": 72.63, "maximum": 74.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "Chemo iv push addl drug", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "minimum": 72.63, "maximum": 74.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "96413 - chemo admin iv push single/first drug first hour", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 589.00, "discounted_cash": 294.50, "minimum": 180.15, "maximum": 345.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 338.50, "methodology": "fee schedule" } ] } ] }, { "description": "Chemo iv infusion 1 hr", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 589.00, "discounted_cash": 294.50, "minimum": 180.15, "maximum": 345.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 338.50, "methodology": "fee schedule" } ] } ] }, { "description": "96415 - chemo admin iv push ea addl hour", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 44.00, "minimum": 72.63, "maximum": 146.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": 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"payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "Chemo iv infusion addl hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 44.00, "minimum": 72.63, "maximum": 146.32, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.63, "methodology": "fee schedule" } ] } ] }, { "description": "96416 chemo prolonged infusion w pump", "code_information": [ { "code": "96416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 589.00, "discounted_cash": 294.50, "minimum": 89.05, "maximum": 345.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": 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Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 471.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 338.50, "methodology": "fee schedule" } ] } ] }, { "description": "Chemo prolong infuse w/pump", "code_information": [ { "code": "96416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 589.00, "discounted_cash": 294.50, "minimum": 89.05, "maximum": 345.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 127.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 89.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 108.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 146.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 345.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 338.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, 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"standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 257.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 180.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 218.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 295.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 70.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.63, "methodology": "fee schedule" }, { "payer_name": 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"standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 61.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hot/cold pack", "code_information": [ { "code": "97010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 23.00, "minimum": 56.61, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl 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] }, { "description": "Ot hot cold pack assistant units", "code_information": [ { "code": "97010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges", "modifiers": "G0" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot hot cold pack units", "code_information": [ { "code": "97010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 23.00, 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"standard_charge_dollar": 13.54, "methodology": "fee schedule" } ] } ] }, { "description": "Pt mechanical traction assistant units", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 30.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges", "modifiers": "CQ" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt mechanical traction units", "code_information": [ { "code": "97012", "type": 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Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 38.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": 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"plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 38.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt unattended e-stim units", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 38.40, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 38.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 38.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Vasopneumatic device therapy", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 15.00, "minimum": 10.98, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 11.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 11.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 10.98, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 10.98, "methodology": "fee schedule" } ] } ] }, { "description": "Pt vasopneumatic devices units", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 15.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 24.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Paraffin bath therapy", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 17.50, "minimum": 5.66, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 5.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 5.66, "methodology": "fee schedule" } ] } ] }, { "description": "Paraffin bath charge", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 17.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot whirlpool", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.00, "discounted_cash": 41.00, "minimum": 14.41, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 14.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 14.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 65.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 65.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 65.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 14.41, "methodology": "fee schedule" } ] } ] }, { "description": "Whirlpool therapy", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.00, "discounted_cash": 41.00, "minimum": 14.41, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 14.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 14.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 65.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 65.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 65.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 14.41, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 14.41, "methodology": "fee schedule" } ] } ] }, { "description": "Application of a modality to 1 or more areas", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "minimum": 13.54, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 13.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 13.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 13.54, "methodology": "fee schedule" } ] } ] }, { "description": "Electrical stimulation", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "minimum": 13.54, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 13.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", 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"standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 13.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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"payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 37.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 37.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot ultrasound", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 46.00, "discounted_cash": 23.00, "minimum": 13.11, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 13.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 13.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 36.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 13.11, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 13.11, "methodology": "fee schedule" } ] } ] }, { "description": "Ultrasound therapy", 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}, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 27.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 27.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 83.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 83.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 83.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 27.21, "methodology": "fee schedule" } ] } ] }, { "description": "Gait training therapy", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 52.00, "minimum": 27.21, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 27.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 27.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 83.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 83.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 83.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 27.21, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 27.21, "methodology": "fee schedule" } ] } ] }, { "description": "Pt gait training assistant units", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges", "modifiers": "CQ" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97116 gait/crutch training charge", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 73.00, "discounted_cash": 36.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 58.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Massage therapy", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 48.00, "minimum": 27.72, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 28.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 28.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 27.72, "methodology": "fee schedule" } ] } ] }, { "description": "Massage therapy (per 15 min)", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 48.00, "minimum": 27.72, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 28.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 28.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 76.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 27.72, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 27.72, "methodology": "fee schedule" } ] } ] }, { "description": "Ot massage units", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Massage charge units", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Massage charge units", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 43.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97129 therapeutic interventions that focus on cognitive function; initial 15 minutes (slp)", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 30.00, "minimum": 20.76, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 21.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 21.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 20.76, "methodology": "fee schedule" } ] } ] }, { "description": "Ther ivntj 1st 15 min", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 30.00, "minimum": 20.76, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 21.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 21.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 20.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 20.76, "methodology": "fee schedule" } ] } ] }, { "description": "Slp cog ther interventfirst 15min units", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 172.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Slp cog ther intervent addl 15min units", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 22.50, "minimum": 20.11, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 20.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 20.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 36.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 36.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 36.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 20.11, "methodology": "fee schedule" } ] } ] }, { "description": "Ther ivntj ea addl 15 min", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 22.50, "minimum": 20.11, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 20.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 20.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 36.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 36.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 36.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 20.11, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 20.11, "methodology": "fee schedule" } ] } ] }, { "description": "97130 therapeutic interventions that focus on cognitive function; each additional 15 minutes (slp)", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 28.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 44.80, "methodology": "percent of total billed charges", "modifiers": "GN" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 44.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 44.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Manual therapy 1/> regions", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 54.00, "minimum": 25.70, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 26.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 26.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 86.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 86.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 86.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 25.70, "methodology": "fee schedule" } ] } ] }, { "description": "Myofacial", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 54.00, "minimum": 25.70, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 26.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 26.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 86.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 86.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 86.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 25.70, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 25.70, "methodology": "fee schedule" } ] } ] }, { "description": "97140 ot manual therapy assistant units", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges", "modifiers": "CO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt manual therapy assistant units", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges", "modifiers": "CQ" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Manual therapy charge units", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 46.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97140 manual therapy charge", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 32.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Group therapeutic procedures", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 21.50, "minimum": 16.56, "maximum": 59.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 36.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 52.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": 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Tricare East", "plan_name": "30770242", "standard_charge_dollar": 16.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 16.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 16.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 16.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 16.56, "methodology": "fee schedule" } ] } ] }, { "description": "97150 ther procedures group", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 21.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 34.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97161 pt evaluation: low complexity", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": 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"Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 92.66, "methodology": "fee schedule" } ] } ] }, { "description": "Pt evaluation low complexity units", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.00, "discounted_cash": 58.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97162 pt eval: moderate complexity 30 min (untimed)", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 232.00, "discounted_cash": 116.00, "minimum": 56.61, "maximum": 94.51, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 92.66, "methodology": "fee schedule" } ] } ] }, { "description": "Pt eval mod complex 30 min", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 232.00, "discounted_cash": 116.00, "minimum": 56.61, "maximum": 94.51, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 92.66, "methodology": "fee schedule" } ] } ] }, { "description": "Pt evaluation moderate complexity units", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 75.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97163 pt eval: high complexity 45 min (untimed)", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 120.00, "minimum": 56.61, "maximum": 94.51, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 94.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 92.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 92.66, "methodology": "fee schedule" } ] } ] }, { "description": "Pt evaluation high complexity units", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 171.00, "discounted_cash": 85.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt re-eval est plan care", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.00, "discounted_cash": 58.50, "minimum": 56.61, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 64.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 64.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 63.57, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 63.57, "methodology": "fee schedule" } ] } ] }, { "description": "Pt re-evaluation units", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.00, "discounted_cash": 58.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 93.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot eval low complex 30 min", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 62.00, "minimum": 90.42, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 96.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 96.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 99.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 99.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 99.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 94.96, "methodology": "fee schedule" } ] } ] }, { "description": "Ot evaluation low complexity units", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 62.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 99.20, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 99.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 99.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot eval mod complex 45 min", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 75.00, "minimum": 90.42, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 96.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 96.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 94.96, "methodology": "fee schedule" } ] } ] }, { "description": "Ot evaluation moderate complexity units", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 150.00, "discounted_cash": 75.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 120.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot eval high complex 60 min", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 171.00, "discounted_cash": 85.50, "minimum": 90.42, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 96.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 96.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 94.96, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", 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"plan_name": "29046253", "standard_charge_dollar": 32.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 32.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 100.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 32.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 32.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 32.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 32.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt therapeutic activity assistant units", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 30.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges", "modifiers": "CQ" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Therapeutic activities charges", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 30.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97530 kinetic act. 15 min. charge", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 46.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sensory integration", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 107.00, "discounted_cash": 53.50, "minimum": 55.56, "maximum": 148.56, "setting": 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"standard_charge_dollar": 56.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 56.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 55.56, "methodology": "fee schedule" } ] } ] }, { "description": "Sensory tx", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 107.00, "discounted_cash": 53.50, "minimum": 55.56, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 56.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 56.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 85.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 55.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 55.56, "methodology": "fee schedule" } ] } ] }, { "description": "Adl/living training (per 15 min)", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.00, "discounted_cash": 63.00, "minimum": 30.09, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 30.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 30.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 100.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 100.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 100.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 30.09, "methodology": "fee schedule" } ] } ] }, { "description": "Self care mngment training", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 126.00, "discounted_cash": 63.00, "minimum": 30.09, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 30.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 30.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 100.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 100.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 100.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 30.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 30.09, "methodology": "fee schedule" } ] } ] }, { "description": "97535 adl training", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 32.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges", "modifiers": "CO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt self care home management assistant units", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 32.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges", "modifiers": "CQ" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pt self care home management charges", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 32.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 52.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97535 actvts of daily lvng charge", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 40.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 64.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ot w/c training", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 55.50, "minimum": 29.05, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 29.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 29.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 29.05, "methodology": "fee schedule" } ] } ] }, { "description": "Wheelchair mngment training", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 55.50, "minimum": 29.05, "maximum": 148.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 129.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 90.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 29.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 29.63, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 88.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 29.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 29.05, "methodology": "fee schedule" } ] } ] }, { "description": "97542 wheelchair management ea 15 min", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 62.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97545 ot work hardening initial charge", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 297.00, "discounted_cash": 148.50, "minimum": 56.61, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 237.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 237.60, "methodology": "percent of total billed charges" }, { "payer_name": 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"payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 353.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 353.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 353.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rmvl devital tis addl 20cm/<", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 442.00, "discounted_cash": 221.00, "minimum": 126.87, "maximum": 126.87, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 126.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 353.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 353.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 353.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97602 removal devital tissue non selctive debridement w/o anes 1 session", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 202.78, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": 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"standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Ot non-selective debrid w/o anes units", "code_information": [ { "code": "97602", "type": "CPT" } ], 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Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Non-selective debridement charge", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 295.00, "discounted_cash": 147.50, "minimum": 202.78, "maximum": 206.83, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule", "modifiers": "GP" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 236.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "Neg press wound tx <=50 cm", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7266.92, "discounted_cash": 3633.46, "minimum": 202.78, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 206.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5813.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5813.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5813.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 202.78, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 202.78, "methodology": "fee schedule" } ] } ] }, { "description": "97606 negative pressure wound therapy >50 sq cm", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Neg press wound tx >50 cm", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 215.00, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 344.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Neg press wnd tx <=50 sq cm", "code_information": [ { "code": "97607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8215.88, "discounted_cash": 4107.94, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6572.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6572.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6572.70, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "97608 - neg press wound tx disposable >50 sq cm", "code_information": [ { "code": "97608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 427.50, "minimum": 407.73, "maximum": 953.01, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 828.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 580.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 704.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 953.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 415.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 407.73, "methodology": "fee schedule" } ] } ] }, { "description": "Neg press wound tx >50 cm", "code_information": [ { "code": "97608", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 855.00, "discounted_cash": 427.50, 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"Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 407.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 684.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", 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"payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 31.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 31.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 31.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 31.25, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 31.25, "methodology": "fee schedule" } ] } ] }, { "description": "Physical performance test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.00, "discounted_cash": 50.50, "minimum": 31.25, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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}, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 31.25, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 31.25, "methodology": "fee schedule" } ] } ] }, { "description": "Pt physical performance assistant test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", 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"plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Orthotic mgmt&traing 1st enc", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 57.50, "minimum": 42.66, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 43.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 43.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 42.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 42.66, "methodology": "fee schedule" } ] } ] }, { "description": "Orthotic mgmt and training charges", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 56.00, "methodology": "percent of total billed charges", "modifiers": "GO" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 56.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 56.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "97760 assessment orthotic mgt", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 57.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 92.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Prosthetic traing 1st enc", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64.00, "discounted_cash": 32.00, "minimum": 37.76, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 38.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 38.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 51.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 51.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 51.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 37.76, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 37.76, "methodology": "fee schedule" } ] } ] }, { "description": "Prosthetic training charges", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64.00, "discounted_cash": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 51.20, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 51.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 51.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Orthc/prostc mgmt sbsq enc", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "minimum": 46.34, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 47.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 47.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 46.34, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 46.34, "methodology": "fee schedule" } ] } ] }, { "description": "Pt orthotic mgmt/train establish charge", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 50.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges", "modifiers": "GP" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 80.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "98925  osteopathic manipulative tx 1-2 body regions techfee", "code_information": [ { "code": "98925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 63.00, "discounted_cash": 31.50, "minimum": 25.82, "maximum": 63.72, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 38.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 55.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 55.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 38.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 26.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 26.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 25.82, "methodology": "fee schedule" } ] } ] }, { "description": "Osteopath manj 1-2 regions", "code_information": [ { "code": "98925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 63.00, "discounted_cash": 31.50, "minimum": 25.82, "maximum": 63.72, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 38.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 55.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 55.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 38.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 63.72, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 26.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 26.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 50.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 25.82, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 25.82, "methodology": "fee schedule" } ] } ] }, { "description": "99151 cons sedate <5 yo 1st 15m same prov", "code_information": [ { "code": "99151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mod sed same phys/qhp <5 yrs", "code_information": [ { "code": "99151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mod sed same phys/qhp 5/>yrs", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14809.86, "discounted_cash": 7404.93, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11847.89, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11847.89, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11847.89, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mod sed same phys/qhp ea", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18750.52, "discounted_cash": 9375.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 15000.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 15000.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 15000.42, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99155 conscious sedation <5 for first 15 minutes (different provider) charge", "code_information": [ { "code": "99155", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mod sed oth phys/qhp <5 yrs", "code_information": [ { "code": "99155", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99156 cons sedate >5y 1st 15min diff prov", "code_information": [ { "code": "99156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mod sed oth phys/qhp 5/>yrs", "code_information": [ { "code": "99156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99157 cons sedate ea add 15min diff provi", "code_information": [ { "code": "99157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Mod sed other phys/qhp ea", "code_information": [ { "code": "99157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99183 hyperbaric treatment", "code_information": [ { "code": "99183", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 257.00, "discounted_cash": 128.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 205.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hyperbaric oxygen therapy", "code_information": [ { "code": "99183", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 257.00, "discounted_cash": 128.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 205.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 205.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99190 xa perfusionist stand-by", "code_information": [ { "code": "99190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 120.50, "minimum": 40.40, "maximum": 40.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Special pump services", "code_information": [ { "code": "99190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 120.50, "minimum": 40.40, "maximum": 40.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 192.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Phlebotomy", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 42.50, "minimum": 131.55, "maximum": 272.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 166.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 237.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 237.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 166.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 201.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 272.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "Therapeutic phleb.", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 42.50, "minimum": 131.55, "maximum": 272.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 166.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 237.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 237.23, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 166.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 201.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 272.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 134.18, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 131.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 131.55, "methodology": "fee schedule" } ] } ] }, { "description": "99202 new patient ov low to moderate", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99203 office visit new pt. level 3", "code_information": [ { "code": "99203", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99203", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Level 4 (126-155) new patient", "code_information": [ { "code": "99204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Level 5 (156-200) new patient", "code_information": [ { "code": "99205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 206.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 206.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99211 office/outpatient est pt may not req phys/qhp", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99212 established office visit level 2 mcd", "code_information": [ { "code": "99212", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99212", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99213 estab pat level 3", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 149.00, "discounted_cash": 74.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 119.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Level 4 (126-155) est. patient", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Level 5 (156-200) est. patient", "code_information": [ { "code": "99215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 206.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 206.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 164.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Discharge dr visit hospice", "code_information": [ { "code": "99238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hospital discharge day", "code_information": [ { "code": "99238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 162.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 129.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99281 ed medical screening exam - tech", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.00, "discounted_cash": 94.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 188.00, "discounted_cash": 94.00, "minimum": 89.86, "maximum": 91.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 91.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 150.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 89.86, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 89.86, "methodology": "fee schedule" } ] } ] }, { "description": "99282- ed visit level 2", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 161.61, "maximum": 164.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.61, "methodology": "fee schedule" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 300.00, "discounted_cash": 150.00, "minimum": 161.61, "maximum": 164.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 164.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 164.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 240.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 161.61, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 161.61, "methodology": "fee schedule" } ] } ] }, { "description": "99283- ed visit level 3 intermediate", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 240.00, "minimum": 282.57, "maximum": 288.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 288.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 288.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 282.57, "methodology": "fee schedule" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 240.00, "minimum": 282.57, "maximum": 288.22, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 288.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 288.22, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 384.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 282.57, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 282.57, "methodology": "fee schedule" } ] } ] }, { "description": "99284- ed visit level 4 moderate", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 780.00, "discounted_cash": 390.00, "minimum": 434.56, "maximum": 443.25, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 624.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 624.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 624.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 434.56, "methodology": "fee schedule" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 780.00, "discounted_cash": 390.00, "minimum": 434.56, "maximum": 443.25, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 443.25, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 624.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 624.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 624.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 434.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 434.56, "methodology": "fee schedule" } ] } ] }, { "description": "99285- ed visit level 5 high decision making", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1050.00, "discounted_cash": 525.00, "minimum": 625.68, "maximum": 638.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 840.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 840.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 840.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 625.68, "methodology": "fee schedule" } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1050.00, "discounted_cash": 525.00, "minimum": 625.68, "maximum": 638.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 840.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 840.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 840.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 625.68, "methodology": "fee schedule" } ] } ] }, { "description": "Critical care first hour", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4977.46, "discounted_cash": 2488.73, "minimum": 859.90, "maximum": 877.10, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 877.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3981.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3981.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3981.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 859.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 859.90, "methodology": "fee schedule" } ] } ] }, { "description": "99292- ed critical care ea add 30 min", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Critical care addl 30 min", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 107.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99406 smoking cessation 3-10 mins charge", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "minimum": 30.40, "maximum": 42.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 30.40, "methodology": "fee schedule" } ] } ] }, { "description": "Behav chng smoking 3-10 min", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "minimum": 30.40, "maximum": 42.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 30.40, "methodology": "fee schedule" } ] } ] }, { "description": "99407 smoking cessation >10 mins charge", "code_information": [ { "code": "99407", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 37.50, "minimum": 30.40, "maximum": 42.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 30.40, "methodology": "fee schedule" } ] } ] }, { "description": "Behav chng smoking > 10 min", "code_information": [ { "code": "99407", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 75.00, "discounted_cash": 37.50, "minimum": 30.40, "maximum": 42.71, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 42.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 31.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 30.40, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 30.40, "methodology": "fee schedule" } ] } ] }, { "description": "99464 att delivery/newborn charge", "code_information": [ { "code": "99464", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 370.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Attendance at delivery", "code_information": [ { "code": "99464", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 370.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 296.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "99465 delivery/birthing room resuscitation", "code_information": [ { "code": "99465", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 937.00, "discounted_cash": 468.50, "minimum": 667.81, "maximum": 3012.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1833.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2619.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2619.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1833.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2226.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3012.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 667.81, "methodology": "fee schedule" } ] } ] }, { "description": "Nb resuscitation", "code_information": [ { "code": "99465", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 937.00, "discounted_cash": 468.50, "minimum": 667.81, "maximum": 3012.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1833.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2619.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2619.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1833.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2226.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3012.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 681.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 749.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 667.81, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 667.81, "methodology": "fee schedule" } ] } ] }, { "description": "A0422 iv administration ambulance charge", "code_information": [ { "code": "A0422", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 67.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ambulance 02 life sustaining", "code_information": [ { "code": "A0422", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 67.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 107.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ambulance mileage one", "code_information": [ { "code": "A0425", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 8.00, "minimum": 8.97, "maximum": 9.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 9.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 9.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 8.97, "methodology": "fee schedule" } ] } ] }, { "description": "Ground mileage", "code_information": [ { "code": "A0425", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 16.00, "discounted_cash": 8.00, "minimum": 8.97, "maximum": 9.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 9.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 9.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 8.97, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 8.97, "methodology": "fee schedule" } ] } ] }, { "description": "A0426 als non emergency ed charge", "code_information": [ { "code": "A0426", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 455.50, "minimum": 278.98, "maximum": 284.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 728.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 728.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 728.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 278.98, "methodology": "fee schedule" } ] } ] }, { "description": "Als 1", "code_information": [ { "code": "A0426", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 911.00, "discounted_cash": 455.50, "minimum": 278.98, "maximum": 284.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 728.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 728.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 728.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 278.98, "methodology": "fee schedule" } ] } ] }, { "description": "A0427 als 1 emergency transport", "code_information": [ { "code": "A0427", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 964.00, "discounted_cash": 482.00, "minimum": 278.98, "maximum": 284.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 278.98, "methodology": "fee schedule" } ] } ] }, { "description": "Als1-emergency", "code_information": [ { "code": "A0427", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 964.00, "discounted_cash": 482.00, "minimum": 278.98, "maximum": 284.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 771.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 278.98, "methodology": "fee schedule" } ] } ] }, { "description": "A0428 bls non emergency", "code_information": [ { "code": "A0428", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 857.00, "discounted_cash": 428.50, "minimum": 278.98, "maximum": 284.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 278.98, "methodology": "fee schedule" } ] } ] }, { "description": "Bls", "code_information": [ { "code": "A0428", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 857.00, "discounted_cash": 428.50, "minimum": 278.98, "maximum": 284.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 278.98, "methodology": "fee schedule" } ] } ] }, { "description": "A0433 als 2", "code_information": [ { "code": "A0433", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1018.00, "discounted_cash": 509.00, "minimum": 278.98, "maximum": 284.56, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 284.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 814.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 278.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 814.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United 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"standard_charge_percentage": 80.0, "estimated_amount": 4.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Exuderm odor sacral 6 x 6.5 msc5475", "code_information": [ { "code": "A6235", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 18.15, "discounted_cash": 9.08, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 14.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 14.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 14.52, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hydrocolld drg >16<=48 w/o b", "code_information": [ { 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"standard_charge_percentage": 80.0, "estimated_amount": 3.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Skin seal protect moisturizr", "code_information": [ { "code": "A6250", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Normal saline-sterile sm.", "code_information": [ { "code": "A6260", 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billed charges" } ] } ] }, { "description": "Tc99m medronate", "code_information": [ { "code": "A9503", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: tl 201 per mci", "code_information": [ { "code": "A9505", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tl201 thallium", "code_information": [ { "code": "A9505", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 29.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 47.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: tc99m pertechnetate per mci", "code_information": [ { "code": "A9512", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 10.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 16.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 16.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 16.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m pertechnetate", "code_information": [ { "code": "A9512", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 10.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 16.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 16.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 16.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Iodine i-123 sod iodide mic", "code_information": [ { "code": "A9516", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 171.00, "discounted_cash": 85.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: i123 per100 uci", "code_information": [ { "code": "A9516", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 171.00, "discounted_cash": 85.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 136.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: tc99m tilmanocept", "code_information": [ { "code": "A9520", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 956.40, "discounted_cash": 478.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 765.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 765.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 765.12, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99 tilmanocept diag 0.5mci", "code_information": [ { "code": "A9520", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 956.40, "discounted_cash": 478.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 765.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 765.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 765.12, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm:ceretec up to 25 mci", "code_information": [ { "code": "A9521", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2083.00, "discounted_cash": 1041.50, "minimum": 802.34, "maximum": 818.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 818.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 818.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1666.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1666.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1666.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 802.34, "methodology": "fee schedule" } ] } ] }, { "description": "Tc99m exametazime", "code_information": [ { "code": "A9521", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2083.00, "discounted_cash": 1041.50, "minimum": 802.34, "maximum": 818.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 818.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 818.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1666.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1666.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1666.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 802.34, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 802.34, "methodology": "fee schedule" } ] } ] }, { "description": "Tah nm: tc99m mebrofenin up to 15 mci", "code_information": [ { "code": "A9537", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 42.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m mebrofenin", "code_information": [ { "code": "A9537", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 85.00, "discounted_cash": 42.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 68.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: dtpa up to 25 mci", "code_information": [ { "code": "A9539", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 51.00, "discounted_cash": 25.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 40.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 40.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 40.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m pentetate", "code_information": [ { "code": "A9539", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 51.00, "discounted_cash": 25.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 40.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 40.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 40.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: maa per study up to 10 mci", "code_information": [ { "code": "A9540", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 204.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m maa", "code_information": [ { "code": "A9540", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 204.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 163.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: tc99m sulfur colloid study 20mci", "code_information": [ { "code": "A9541", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 385.00, "discounted_cash": 192.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 308.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 308.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 308.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m sulfur colloid", "code_information": [ { "code": "A9541", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 385.00, "discounted_cash": 192.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 308.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 308.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 308.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "In111 oxyquinoline", "code_information": [ { "code": "A9547", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 401.00, "discounted_cash": 200.50, "minimum": 772.64, "maximum": 788.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 788.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 788.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 320.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 320.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 320.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 772.64, "methodology": "fee schedule" } ] } ] }, { "description": "Tah nm: in111 pentetreotide 0.5 mci", "code_information": [ { "code": "A9547", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 401.00, "discounted_cash": 200.50, "minimum": 772.64, "maximum": 788.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 788.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 788.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 320.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 320.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 320.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 772.64, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 772.64, "methodology": "fee schedule" } ] } ] }, { "description": "F18 fdg", "code_information": [ { "code": "A9552", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 590.00, "discounted_cash": 295.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 472.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 472.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 472.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: dmsa per dose", "code_information": [ { "code": "A9552", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 590.00, "discounted_cash": 295.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 472.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 472.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 472.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ga67 gallium", "code_information": [ { "code": "A9556", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 38.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm:ga67 per mci", "code_information": [ { "code": "A9556", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 38.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 60.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: ultratag rbc/tc99m <= 30 mci", "code_information": [ { "code": "A9560", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 4.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m labeled rbc", "code_information": [ { "code": "A9560", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 9.00, "discounted_cash": 4.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: hdp up to 30 mci", "code_information": [ { "code": "A9561", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m oxidronate", "code_information": [ { "code": "A9561", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 161.00, "discounted_cash": 80.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 128.80, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tah nm: mag3 per mci <15.00", "code_information": [ { "code": "A9562", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Tc99m mertiatide", "code_information": [ { "code": "A9562", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gadoteridol 279.3 mg/ml sol 20 ml", "drug_information": { "unit": "20.00", "type": "ML" }, "code_information": [ { "code": "A9576", "type": "HCPCS" }, { "code": "00270-1111-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 264.87, "discounted_cash": 132.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 211.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 211.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 211.90, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gadobenate dimeglumine 529 mg/ml iv sol 5 ml", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "A9577", "type": "HCPCS" }, { "code": "00270-5164-12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 110.36, "discounted_cash": 55.18, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 88.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 88.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 88.29, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gadobenate dimeglumine 529 mg/ml iv sol 10 ml", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "A9577", "type": "HCPCS" }, { "code": "00270-5164-13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 188.46, "discounted_cash": 94.23, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 150.77, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 150.77, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 150.77, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gadobenate dimeglumine 529 mg/ml iv sol 15 ml", "drug_information": { "unit": "15.00", "type": "ML" }, "code_information": [ { "code": "A9577", "type": "HCPCS" }, { "code": "00270-5164-14", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 214.52, "discounted_cash": 107.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 171.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 171.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 171.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gadobenate dimeglumine 529 mg/ml iv sol 20 ml", "drug_information": { "unit": "20.00", "type": "ML" }, "code_information": [ { "code": "A9577", "type": "HCPCS" }, { "code": "00270-5164-15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 265.02, "discounted_cash": 132.51, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 212.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 212.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 212.02, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gad-base mr contrast nos1ml", "code_information": [ { "code": "A9579", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Seq gadoteriodl (prohance)", "code_information": [ { "code": "A9579", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 6.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Gadoxetate 181.43 mg/ml sol 10 ml", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "A9581", "type": "HCPCS" }, { "code": "50419-0320-05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 357.84, "discounted_cash": 178.92, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 286.27, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 286.27, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 286.27, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Florbetapir f18", "code_information": [ { "code": "A9586", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3634.80, "discounted_cash": 1817.40, "minimum": 2194.62, "maximum": 2238.51, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2238.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2238.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2907.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2907.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2907.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" } ] } ] }, { "description": "Tah amyvid ( florbetapir f18)", "code_information": [ { "code": "A9586", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3634.80, "discounted_cash": 1817.40, "minimum": 2194.62, "maximum": 2238.51, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2238.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 2238.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2907.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2194.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc 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"29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1904.11, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1866.77, "methodology": "fee schedule" } ] } ] }, { "description": "C5274 app skn sub grft t/a/l area>=100scm adl 100sqcm", "code_information": [ { "code": "C5274", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Low cost skin substitute app", "code_information": [ { "code": "C5274", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3908.00, "discounted_cash": 1954.00, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3126.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C5275 sub grft f/s/n/h/f/g/m/d <100sq cm 1st 25 sq cm", "code_information": [ { "code": "C5275", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1345.00, "discounted_cash": 672.50, "minimum": 624.69, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "Low cost skin substitute app", "code_information": [ { "code": "C5275", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1345.00, "discounted_cash": 672.50, "minimum": 624.69, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 624.69, "methodology": "fee schedule" } ] } ] }, { "description": "C5276 sub grft f/s/n/h/f/g/m/d<100sq cm ea addl25sq cm", "code_information": [ { "code": "C5276", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1345.00, "discounted_cash": 672.50, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Low cost skin substitute app", "code_information": [ { "code": "C5276", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1345.00, "discounted_cash": 672.50, "minimum": 4013.95, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C5277 sub grft f/s/n/h/f/g/m/d >= 100scm 1st 100sq cm", "code_information": [ { "code": "C5277", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1345.00, "discounted_cash": 672.50, "minimum": 624.69, "maximum": 6595.07, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 5734.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 4013.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 4874.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 6595.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 637.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1076.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 624.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 624.69, 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Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3328.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "C8912 magnetic 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2615.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3539.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 889.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 872.37, "methodology": "fee schedule" } ] } ] }, { "description": "C8913 magnetic resonance angiography w/out contrast", "code_information": [ { "code": "C8913", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 667.00, "discounted_cash": 333.50, "minimum": 551.36, "maximum": 3539.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 3077.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2154.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2615.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3539.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 562.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 533.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 533.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 533.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 551.36, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 551.36, "methodology": "fee schedule" } ] } ] }, { "description": "Mra w/o cont lwr ext", "code_information": [ { 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"standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 872.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 727.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", 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Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transthoracic echocardio w/contrast1", "code_information": [ { "code": "C8922", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", 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schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Tte w or w/o fol w/cont f/u", "code_information": [ { "code": "C8922", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, 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}, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, 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"standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transthoracic echocardio w/contrast2", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { 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"standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "2d tte w or w/o fol w/confu", "code_information": [ { "code": "C8924", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1469.03, "discounted_cash": 734.52, "minimum": 364.46, "maximum": 496.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1175.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1175.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1175.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "2d tee w or w/o fol w/conin", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transesophageal echo", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { 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Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transesophageal w/ contrast", "code_information": [ { "code": "C8926", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { 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"29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transesophageal w/ contrast1", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": 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{ "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Echo:transesophageal echo1", "code_information": [ { "code": "C8928", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1978.00, "discounted_cash": 989.00, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", 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"standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Tte w or w/o fol w/constres", "code_information": [ { "code": "C8928", "type": "HCPCS" } ], "standard_charges": [ { 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806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, 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billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1582.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Tte w or wo fol wcondoppler", "code_information": [ { "code": "C8929", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6962.78, "discounted_cash": 3481.39, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, 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"standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5570.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5570.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5570.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Tte w or w/o contr cont ecg", "code_information": [ { "code": "C8930", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2356.59, "discounted_cash": 1178.30, "minimum": 496.02, "maximum": 822.40, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 496.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 822.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1885.27, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1885.27, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1885.27, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 806.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 806.28, "methodology": "fee schedule" } ] } ] }, { "description": "Bupivacaine-meloxicam 200 mg-6 mg/7 ml ers", "drug_information": { "unit": "7.00", "type": "ML" }, "code_information": [ { "code": "C9088", "type": "HCPCS" }, { "code": "47426-0503-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 399.92, "discounted_cash": 199.96, "minimum": 0.79, "maximum": 0.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 319.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 319.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 319.94, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.79, "methodology": "fee schedule" } ] } ] }, { "description": "Bupivacaine-meloxicam 200 mg-6 mg/7 ml ers", "drug_information": { "unit": "7.00", "type": "ML" }, "code_information": [ { "code": "C9088", "type": "HCPCS" }, { "code": "47426-0303-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 385.84, "discounted_cash": 192.92, "minimum": 0.79, "maximum": 0.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 308.67, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 308.67, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 308.67, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.79, "methodology": "fee schedule" } ] } ] }, { "description": "Aprepitant 32 mg/4.4 ml inj soln", "drug_information": { "unit": "4.40", "type": "ML" }, "code_information": [ { "code": "C9145", "type": "HCPCS" }, { "code": "47426-0401-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 182.82, "discounted_cash": 91.41, "minimum": 1.90, "maximum": 1.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 1.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 1.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 146.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 146.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 146.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1.90, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1.90, "methodology": "fee schedule" } ] } ] }, { "description": "Clevidipine 0.5 mg/ml 50 ml emu", "drug_information": { "unit": "50.00", "type": "ML" }, "code_information": [ { "code": "C9248", "type": "HCPCS" }, { "code": "10122-0610-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 222.60, "discounted_cash": 111.30, "minimum": 1.14, "maximum": 2.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 2.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 2.86, "methodology": "fee schedule" }, { "payer_name": 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Medicare", "plan_name": "30770134", "standard_charge_dollar": 2.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 2.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 2.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 2.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 2.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 178.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 178.08, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl 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18325.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13283.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13283.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 13283.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 18325.26, "methodology": "fee schedule" } ] } ] }, { "description": "C9608 des pci of cto branch/graf ea add vessel", "code_information": [ { "code": "C9608", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 8034.00, "discounted_cash": 4017.00, "minimum": 20313.86, "maximum": 33376.45, "setting": "both", "payers_information": [ 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 20313.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 24668.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 33376.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6427.20, "methodology": "percent of total billed charges" } ] } ] }, { "description": "C9773 revasc lithotr-stent tib/per", "code_information": [ { "code": "C9733", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 39730.00, "discounted_cash": 19865.00, "minimum": 40.40, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 40.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 371.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { 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Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 31784.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 31784.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 364.46, "methodology": "fee schedule" } ] } ] }, { "description": "Non-ophthalmic fva", "code_information": [ { "code": "C9733", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 39730.00, "discounted_cash": 19865.00, "minimum": 40.40, "maximum": 371.75, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 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"30770134", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 364.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 31784.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 31784.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans 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"Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "G0009 admin of pneu vac", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 17.00, "minimum": 47.09, "maximum": 48.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 48.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": 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"30770134", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 27.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 47.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 47.09, "methodology": "fee schedule" } ] } ] }, { "description": "Psa screening", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 33.00, "minimum": 19.31, "maximum": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 27.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 19.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 19.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 52.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 52.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 52.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 19.31, "methodology": "fee schedule" } ] } ] }, { "description": "Psa screen", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 19.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 19.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 52.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 19.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 52.80, "methodology": "percent of total billed charges" }, { "payer_name": 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"payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2781.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2781.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2781.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 930.42, "methodology": "fee schedule" } ] } ] }, { "description": "Colon ca scrn not hi rsk ind", "code_information": [ { "code": "G0121", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3820.45, "discounted_cash": 1910.23, "minimum": 930.42, "maximum": 1320.57, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1320.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 949.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3056.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3056.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3056.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 930.42, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 930.42, "methodology": "fee schedule" } ] } ] }, { "description": "G0127 trim dystrophic nails any number tech fee", "code_information": [ { "code": "G0127", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 65.00, "minimum": 60.62, "maximum": 320.67, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 278.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 195.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 237.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 320.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", 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"plan_name": "29046164", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", 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East", "plan_name": "30770242", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 104.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.62, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.62, "methodology": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 109.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 148.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 185.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Occupational therapy hh", "code_information": [ { "code": "G0152", "type": "HCPCS" } ], "standard_charges": [ { 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863.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 750.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 525.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 637.98, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 863.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 143.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 143.54, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 140.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 140.73, "methodology": "fee schedule" } ] } ] }, { "description": "Seq 3d/tomo bilateral", "code_information": [ { "code": "G0279", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 186.00, "discounted_cash": 93.00, "minimum": 40.08, "maximum": 301.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", 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East", "plan_name": "30770242", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 148.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 148.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 40.08, "methodology": 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"standard_charge_dollar": 301.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 40.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 40.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 148.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 40.08, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 11.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 11.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 11.56, "methodology": "fee schedule" } ] } ] }, { "description": "Ultrasound", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 24.50, "minimum": 11.56, "maximum": 93.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 80.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 68.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 93.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 11.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 11.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 39.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 11.56, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 11.56, "methodology": "fee schedule" } ] } ] }, { "description": "Hhs/hospice of rn ea 15 min", "code_information": [ { "code": "G0299", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Rn hh direct skilled nursing", "code_information": [ { "code": "G0299", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hhs/hospice of lpn ea 15 min", "code_information": [ { "code": "G0300", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Lpn hh or ho direct skilled nursing", "code_information": [ { "code": "G0300", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 153.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Hospital observation per hr", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 31.00, "minimum": 43.61, "maximum": 43.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 43.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 43.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 43.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 43.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 43.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 43.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Room/bed: observation", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 31.00, "minimum": 43.61, "maximum": 43.61, "setting": "both", "payers_information": [ { 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Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Direct refer hospital observ", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 31.00, "minimum": 625.68, "maximum": 638.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 625.68, "methodology": "fee schedule" } ] } ] }, { "description": "G0379 direct referal to op obs charge", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 31.00, "minimum": 625.68, "maximum": 638.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 638.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 49.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 625.68, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 625.68, "methodology": "fee schedule" } ] } ] }, { "description": "95806 sleep home study", "code_information": [ { "code": "G0399", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 773.00, "discounted_cash": 386.50, "minimum": 159.67, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "Home sleep test/type 3 porta", "code_information": [ { "code": "G0399", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 773.00, "discounted_cash": 386.50, "minimum": 159.67, "maximum": 162.86, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 162.86, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 618.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 159.67, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 159.67, "methodology": "fee schedule" } ] } ] }, { "description": "G0416-prostate biopsies > 1", "code_information": [ { "code": "G0416", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 587.00, "discounted_cash": 293.50, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 469.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 469.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 469.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 367.10, "methodology": "fee schedule" } ] } ] }, { "description": "Prostate biopsy any mthd", "code_information": [ { "code": "G0416", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 587.00, "discounted_cash": 293.50, "minimum": 118.20, "maximum": 374.44, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 118.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 374.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 367.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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] } ] }, { "description": "Hiv 1/2 antibody & antigen", "code_information": [ { "code": "G0435", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 33.00, "minimum": 11.98, "maximum": 21.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 21.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 21.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 21.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 21.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 21.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 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"standard_charge_dollar": 1.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 1.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 1.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 1.70, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 770.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 770.12, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 1.70, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 1.70, "methodology": "fee schedule" } ] } ] }, { "description": "Amifostine 500 mg iv inj", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J0207", "type": "HCPCS" }, { "code": "55390-0308-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1080.00, "discounted_cash": 540.00, "minimum": 113.69, "maximum": 113.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 864.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 864.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 864.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Remdesivir 100 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J0248", "type": "HCPCS" }, { "code": "61958-2901-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1123.20, "discounted_cash": 561.60, "minimum": 6.48, "maximum": 6.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"plan_name": "29046215", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 898.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 898.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 6.48, "methodology": "fee schedule" } ] } ] }, { "description": "Remdesivir 100 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J0248", "type": "HCPCS" }, { "code": "61958-2901-02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1371.28, "discounted_cash": 685.64, "minimum": 6.48, "maximum": 6.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 6.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 6.48, 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"standard_charge_dollar": 5.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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"standard_charge_dollar": 6.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 215.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 6.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 6.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 6.46, "methodology": "fee 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 604.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 604.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 6.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 6.46, "methodology": "fee schedule" } ] } ] }, { "description": "Decitabine 50 mg iv inj", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J0894", "type": "HCPCS" }, { "code": "16729-0224-05", "type": "NDC" } ], 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"plan_name": "30770242", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3240.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3240.75, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 27.66, "methodology": "fee schedule" } ] } ] }, { "description": "Denosumab 120 mg/1.7 ml sol", "drug_information": { "unit": "1.70", "type": "ML" }, "code_information": [ { "code": "J0897", "type": "HCPCS" }, { "code": "55513-0730-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7451.44, "discounted_cash": 3725.72, "minimum": 12.12, "maximum": 28.21, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 28.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 28.21, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", 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"standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5961.15, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5961.15, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 27.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 27.66, "methodology": "fee schedule" } ] } ] }, { "description": "Estradiol cypionate 5 mg/ml im sol 5 ml", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "J1000", "type": "HCPCS" }, { "code": "00009-0271-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 574.86, "discounted_cash": 287.43, "minimum": 12.12, "maximum": 12.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 459.89, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 459.89, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 459.89, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methylprednisolone acetate 40 mg/ml inj susp", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009-0280-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.70, "discounted_cash": 18.35, "minimum": 0.12, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 29.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": 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"payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.12, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone acetate 80 mg/1 ml inj susp", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009-3475-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 73.35, "discounted_cash": 36.68, "minimum": 0.12, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", 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Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.12, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone acetate 80 mg/1 ml inj susp", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009-3475-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 73.38, "discounted_cash": 36.69, "minimum": 0.12, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.12, "methodology": "fee 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}, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8.93, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 10 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00703-0110-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.99, "discounted_cash": 6.50, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 50 mg/5ml inj sol", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00703-0113-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.04, "discounted_cash": 17.52, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 28.03, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28.03, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28.03, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 2 mg/ml inj sol 20 ml", "drug_information": { "unit": "20.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00641-2341-41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 79.98, "discounted_cash": 39.99, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 63.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 63.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 63.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 2 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00641-0121-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.90, "discounted_cash": 3.95, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 0.5 mg/0.5 ml sol", "drug_information": { "unit": "0.50", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-1283-04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.90, "discounted_cash": 3.95, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 0.5 mg/0.5 ml sol", "drug_information": { "unit": "0.50", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-1283-05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.83, "discounted_cash": 6.42, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 1 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-1283-31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.67, "discounted_cash": 4.84, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 1 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-1283-37", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.23, "discounted_cash": 9.12, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 14.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 14.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 14.58, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 4 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-1304-31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.64, "discounted_cash": 5.32, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 8.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 8.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 8.51, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 2 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-1312-30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.52, "discounted_cash": 6.26, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 2 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-3365-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.90, "discounted_cash": 3.95, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 2 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-3365-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.90, "discounted_cash": 3.95, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 10 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-2634-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.93, "discounted_cash": 7.97, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 50 mg/5ml inj sol", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-2634-05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.52, "discounted_cash": 20.26, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 32.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 32.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 32.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 0.5 mg/0.5 ml sol", "drug_information": { "unit": "0.50", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "00409-4264-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.83, "discounted_cash": 5.92, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 1mg/ml pca 30ml", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "99998-9999-31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 106.95, "discounted_cash": 53.48, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 85.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 85.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 85.56, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 0.5 mg/0.5 ml sol", "drug_information": { "unit": "0.50", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "76045-0009-05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.39, "discounted_cash": 6.70, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 0.5 mg/0.5 ml sol", "drug_information": { "unit": "0.50", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "76045-0009-06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.44, "discounted_cash": 7.72, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 1 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "76045-0009-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.39, "discounted_cash": 6.70, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 2 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "76045-0010-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.39, "discounted_cash": 6.70, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 1mg/ml pca 30ml", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "70092-1117-79", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.43, "discounted_cash": 4.22, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 10 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "17478-0540-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.30, "discounted_cash": 4.65, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 50 mg/5ml inj sol", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "17478-0540-05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.69, "discounted_cash": 13.35, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 21.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 21.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 21.35, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 10 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "63323-0851-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.57, "discounted_cash": 7.29, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 50 mg/5ml inj sol", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "63323-0851-15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 51.71, "discounted_cash": 25.86, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 41.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 41.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 41.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 1 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "63323-0852-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.39, "discounted_cash": 6.70, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 2 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "63323-0853-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.39, "discounted_cash": 6.70, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Hydromorphone 4 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1171", "type": "HCPCS" }, { "code": "63323-0854-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.88, "discounted_cash": 6.94, "minimum": 0.09, "maximum": 0.09, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.09, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.09, "methodology": "fee schedule" } ] } ] }, { "description": "Dexrazoxane 500 mg rec inj", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J1190", "type": "HCPCS" }, { "code": "55150-0437-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1184.78, "discounted_cash": 592.39, "minimum": 80.88, "maximum": 113.69, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 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"payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 5.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 5.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 5.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 66.81, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 66.81, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 66.81, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dobutamine 250 mg/20 ml iv 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"plan_name": "29030835", "standard_charge_dollar": 5.31, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 19.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19.34, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Dobutamine 250 mg/20 ml iv sol", "drug_information": { "unit": "20.00", "type": "ML" }, "code_information": [ { "code": "J1250", "type": "HCPCS" }, { "code": "00143-9141-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.52, "discounted_cash": 14.26, "minimum": 5.31, "maximum": 5.31, "setting": "both", 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{ "gross_charge": 21.70, "discounted_cash": 10.85, "minimum": 0.50, "maximum": 0.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 17.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17.36, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Ravulizumab 300mg/ 3ml inj sol", "drug_information": { "unit": "3.00", "type": "ML" }, "code_information": [ { "code": "J1303", "type": "HCPCS" }, { "code": "25682-0025-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14109.29, "discounted_cash": 7054.65, "minimum": 113.69, "maximum": 225.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 225.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 225.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11287.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11287.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11287.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 220.59, "methodology": "fee schedule" } ] } ] }, { "description": "Ravulizumab 1100mg / 11ml inj sol", "drug_information": { "unit": "11.00", "type": "ML" }, "code_information": [ { "code": "J1303", "type": "HCPCS" }, { "code": "25682-0028-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 51734.07, "discounted_cash": 25867.04, "minimum": 113.69, "maximum": 225.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 225.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 225.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 41387.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 41387.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 41387.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 220.59, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 220.59, "methodology": "fee schedule" } ] } ] }, { "description": "Inclisiran 284 mg/1.5 ml sol", "drug_information": { "unit": "1.50", "type": "ML" }, "code_information": [ { "code": "J1306", "type": "HCPCS" }, { "code": "00078-1000-60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7286.57, "discounted_cash": 3643.29, "minimum": 12.53, "maximum": 12.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 12.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 12.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 12.78, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 12.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 12.53, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare 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"plan_name": "30770266", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 785.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 785.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.40, "methodology": "fee schedule" } ] } ] }, { "description": "Tbo-filgrastim 300 mcg/0.5 ml sol", "drug_information": { "unit": "1.00", "type": "ML" }, 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"payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 785.23, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 785.23, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 785.23, "methodology": "percent of total billed charges" }, { 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"29739437", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1030.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1030.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1030.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.40, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.40, "methodology": "fee schedule" } ] } ] }, { "description": "Trilaciclib 300 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J1448", "type": "HCPCS" }, { "code": "73462-0101-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3378.24, "discounted_cash": 1689.12, "minimum": 5.37, "maximum": 5.48, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2702.59, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5.37, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"type": "ML" }, "code_information": [ { "code": "J1450", "type": "HCPCS" }, { "code": "70655-0002-06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.70, "discounted_cash": 10.85, "minimum": 2.65, "maximum": 2.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 17.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 17.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 17.36, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Fluconazole 200 mg/100 ml-ns iv sol", "drug_information": { "unit": "100.00", "type": "ML" }, "code_information": [ { "code": "J1450", "type": "HCPCS" }, { "code": "25021-0184-66", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.50, "discounted_cash": 7.75, "minimum": 2.65, "maximum": 2.65, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", 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"discounted_cash": 8132.40, "minimum": 25.01, "maximum": 50.27, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 50.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 50.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13011.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13011.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 13011.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 49.28, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 49.28, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (hizentra) subq 20% 1 gm/5 ml sol", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "J1559", "type": "HCPCS" }, { "code": "44206-0451-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 492.20, "discounted_cash": 246.10, "minimum": 12.12, "maximum": 13.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 13.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 13.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 393.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 393.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 393.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 13.64, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 13.64, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gamunex-c) iv-subq 10% sol 2.5 gm/25 ml", "drug_information": { "unit": "25.00", "type": "ML" }, "code_information": [ { "code": "J1561", "type": "HCPCS" }, { "code": "13533-0800-15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 565.50, "discounted_cash": 282.75, "minimum": 25.01, "maximum": 49.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 49.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 49.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 452.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 452.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 452.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 49.01, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gamunex-c) iv-subq 10% sol 20 gm/200 ml", "drug_information": { "unit": "200.00", "type": "ML" }, "code_information": [ { "code": "J1561", "type": "HCPCS" }, { "code": "13533-0800-24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4176.00, "discounted_cash": 2088.00, "minimum": 25.01, "maximum": 49.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 49.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 49.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3340.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 49.01, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gamunex-c) iv -subq 10% sol 10 gm/100 ml", "drug_information": { "unit": "100.00", "type": "ML" }, "code_information": [ { "code": "J1561", "type": "HCPCS" }, { "code": "13533-0800-71", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2088.00, "discounted_cash": 1044.00, "minimum": 25.01, "maximum": 49.99, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 49.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 49.99, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1670.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 49.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 49.01, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gammagard s/d) iv 5 g rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J1566", "type": "HCPCS" }, { "code": "00944-2656-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2458.30, "discounted_cash": 1229.15, "minimum": 25.01, "maximum": 83.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 83.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 83.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1966.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1966.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1966.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 81.43, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 81.43, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (privigen) 10% 5 gm/ 50 ml", "drug_information": { "unit": "50.00", "type": "ML" }, "code_information": [ { "code": "J1568", "type": "HCPCS" }, { "code": "44206-0436-05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2033.10, "discounted_cash": 1016.55, "minimum": 25.01, "maximum": 50.29, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1626.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1626.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1626.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 49.30, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (privigen) 10% 10 gm/100 ml iv sol", "drug_information": { "unit": 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"standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6505.92, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6505.92, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", 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"standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 747.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 747.36, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 50.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2975.04, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2975.04, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2975.04, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 49.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 49.30, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gammagard liq) iv-subq 10% sol 10 ml", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "J1569", "type": "HCPCS" }, { "code": "00944-2700-02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 408.53, "discounted_cash": 204.27, "minimum": 25.01, "maximum": 47.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 326.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 326.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 326.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 46.46, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gammagard liq) iv-subq 10% 25 ml", "drug_information": { "unit": "25.00", "type": "ML" }, "code_information": [ { "code": "J1569", "type": "HCPCS" }, { "code": "00944-2700-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 942.75, "discounted_cash": 471.38, "minimum": 25.01, "maximum": 47.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 754.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 754.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 754.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 46.46, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gammagard liq) iv-subq 10% sol 50 ml", "drug_information": { "unit": "50.00", "type": "ML" }, "code_information": [ { "code": "J1569", "type": "HCPCS" }, { "code": "00944-2700-04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2048.63, "discounted_cash": 1024.32, "minimum": 25.01, "maximum": 47.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1638.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1638.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1638.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 46.46, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gammagard liq) iv-subq10% sol 100 ml", "drug_information": { "unit": "100.00", "type": "ML" }, "code_information": [ { "code": "J1569", "type": "HCPCS" }, { "code": "00944-2700-05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3771.00, "discounted_cash": 1885.50, "minimum": 25.01, "maximum": 47.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3016.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3016.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3016.80, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 46.46, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gammagard liq) iv-subq 10% sol 200 ml", "drug_information": { "unit": "200.00", "type": "ML" }, "code_information": [ { "code": "J1569", "type": "HCPCS" }, { "code": "00944-2700-06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7543.15, "discounted_cash": 3771.58, "minimum": 25.01, "maximum": 47.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6034.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6034.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6034.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 46.46, "methodology": "fee schedule" } ] } ] }, { "description": "Immune globulin (gammagard liq) 10% 30 gm/300 ml", "drug_information": { "unit": "300.00", "type": "ML" }, "code_information": [ { "code": "J1569", "type": "HCPCS" }, { "code": "00944-2700-07", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11313.00, "discounted_cash": 5656.50, "minimum": 25.01, "maximum": 47.39, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 25.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 46.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 47.39, "methodology": "fee schedule" }, { 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Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.58, "methodology": "fee schedule" } ] } ] }, { "description": "Glycopyrrolate 0.2 mg/ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1596", "type": "HCPCS" }, { "code": "16714-0536-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.51, "discounted_cash": 5.26, "minimum": 0.58, "maximum": 0.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { 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}, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": 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}, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 16.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 16.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.77, "methodology": "fee schedule" } ] } ] }, { "description": "Ketorolac 60 mg/2 ml inj sol", "drug_information": { "unit": "2.00", "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "63323-0162-02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.50, "discounted_cash": 15.25, "minimum": 0.50, "maximum": 0.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 0.50, 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Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.77, "methodology": "fee schedule" } ] } ] }, { "description": "Ketorolac 15 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "72266-0234-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.90, "discounted_cash": 3.95, "minimum": 0.50, "maximum": 0.78, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { 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"payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.58, "methodology": "fee schedule" } ] } ] }, { "description": "Bumetanide 2.5mg/10ml", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J1939", "type": "HCPCS" }, { "code": "00641-6007-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.90, "discounted_cash": 3.95, "minimum": 0.58, "maximum": 0.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.58, "methodology": 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0.58, "methodology": "fee schedule" } ] } ] }, { "description": "Bumetanide 1 mg/4 ml inj sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": [ { "code": "J1939", "type": "HCPCS" }, { "code": "00641-6008-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.28, "discounted_cash": 5.64, "minimum": 0.58, "maximum": 0.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", 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"standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 9.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 9.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.58, "methodology": "fee schedule" } ] } ] }, { "description": 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Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.58, "methodology": "fee schedule" } ] } ] }, { "description": "Bumetanide 1 mg/4 ml inj sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": 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"payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.58, "methodology": "fee schedule" } ] } ] }, { "description": "Bumetanide 1 mg/4 ml inj sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": [ { "code": "J1939", "type": "HCPCS" }, { "code": "68462-0469-54", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.43, "discounted_cash": 4.22, "minimum": 0.58, "maximum": 0.59, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.58, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.58, "methodology": "fee schedule" } ] } ] }, { "description": "Bumetanide 1 mg/4 ml inj sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": [ { "code": "J1939", "type": "HCPCS" }, { "code": "00641-6161-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.43, "discounted_cash": 4.22, "minimum": 0.58, 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"payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 43.32, "methodology": "fee schedule" } ] } ] }, { "description": "Oritavancin 400 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2406", "type": "HCPCS" }, { "code": "70842-0140-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2507.35, "discounted_cash": 1253.68, "minimum": 43.32, "maximum": 44.19, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 43.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 44.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 44.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 43.32, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 43.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 43.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 43.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2005.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2005.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 43.32, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 43.32, "methodology": "fee schedule" } ] } ] }, { "description": "Paliperidone 156 mg/ml er", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J2426", "type": "HCPCS" }, { "code": "50458-0563-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4821.42, "discounted_cash": 2410.71, "minimum": 12.12, "maximum": 15.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs 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"50458-0564-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7709.36, "discounted_cash": 3854.68, "minimum": 12.12, "maximum": 15.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 15.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 15.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6167.49, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6167.49, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6167.49, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 14.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 14.73, "methodology": "fee schedule" } ] } ] }, { "description": "Pamidronate 30 mg/10 ml iv sol", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "J2430", "type": "HCPCS" }, { "code": "61703-0324-18", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.63, "discounted_cash": 26.82, "minimum": 12.12, "maximum": 12.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 42.90, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 42.90, 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"payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 111.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 111.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 111.60, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Pamidronate 30 mg/10 ml 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"standard_charge_percentage": 80.0, "estimated_amount": 26.41, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 26.41, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 26.41, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sodium ferric gluconate complex 62.5 mg/5 ml iv sol", "drug_information": { "unit": "5.00", "type": "ML" }, "code_information": [ { "code": "J2916", "type": "HCPCS" }, { "code": "00591-0149-87", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 118.27, "discounted_cash": 59.14, "minimum": 1.14, "maximum": 1.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 94.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 94.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 94.62, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Methylprednisolone 40 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00143-9753-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.19, "discounted_cash": 7.60, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 12.15, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12.15, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12.15, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 125 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00143-9754-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.03, "discounted_cash": 12.02, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 19.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19.22, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 500 mg rec inj", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009-0758-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 90.33, "discounted_cash": 45.17, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 72.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 72.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 72.26, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 1 g preservative-free rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009-0018-20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 190.21, "discounted_cash": 95.11, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 152.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 152.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 152.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 40 mg/1 ml pf rec", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009-0039-28", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.06, "discounted_cash": 12.03, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 19.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 40 mg/1 ml pf rec", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009-0039-32", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.06, "discounted_cash": 12.03, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 19.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 19.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 19.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 125 mg preservative-free rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009-0047-22", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.22, "discounted_cash": 18.11, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 125 mg preservative-free rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009-0047-26", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.22, "discounted_cash": 18.11, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { 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Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 28.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 28.98, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 1 g rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "00009-0698-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 153.06, "discounted_cash": 76.53, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 122.45, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 122.45, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 122.45, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 1 g rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "63323-0265-30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 127.29, "discounted_cash": 63.65, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 101.83, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 101.83, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 101.83, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 40 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "63323-0255-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.63, "discounted_cash": 11.32, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 18.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 18.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 18.10, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 125 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "63323-0258-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.34, "discounted_cash": 21.67, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 34.67, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 34.67, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 34.67, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 40 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "43598-0127-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.86, "discounted_cash": 8.93, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 14.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 14.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 14.29, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": 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"plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 22.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 22.62, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Methylprednisolone 1 g rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J2919", "type": "HCPCS" }, { "code": "43598-0130-74", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 120.90, "discounted_cash": 60.45, "minimum": 0.27, "maximum": 0.28, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.28, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 96.72, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 96.72, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 96.72, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.27, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.27, "methodology": "fee schedule" } ] } ] }, { "description": "Alteplase 2 mg iv inj", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J2997", "type": "HCPCS" }, { "code": "50242-0041-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 433.27, "discounted_cash": 216.64, "minimum": 56.84, "maximum": 93.31, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 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"plan_name": "29043841", "standard_charge_dollar": 91.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 91.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 91.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 91.48, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7603.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7603.52, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 91.48, "methodology": "fee schedule" }, { 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Eldercare", "plan_name": "29046164", "standard_charge_dollar": 162.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 162.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 162.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 162.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 162.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 162.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 14337.66, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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11.49, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4542.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4542.76, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 11.49, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 11.49, "methodology": "fee schedule" } ] } ] }, { "description": "Chlorpromazine 25 mg/1 ml inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "J3230", "type": "HCPCS" }, { "code": "00641-1397-35", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 107.48, "discounted_cash": 53.74, 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"payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 77.10, "methodology": "fee schedule" } ] } ] }, { "description": "Bendamustine 100 mg/4 ml sol inj", "drug_information": { "unit": "0.04", "type": "ML" }, "code_information": [ { "code": "J9056", "type": "HCPCS" }, { "code": "71225-0120-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 121.78, "discounted_cash": 60.89, "minimum": 29.24, "maximum": 29.82, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 29.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 29.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 29.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 29.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 29.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 29.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 29.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 97.42, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 29.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 29.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 29.24, 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"standard_charge_dollar": 0.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 609.81, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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"estimated_amount": 609.81, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.88, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.88, "methodology": "fee schedule" } ] } ] }, { "description": "Cyclophosphamide 1000 mg iv inj", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J9075", "type": "HCPCS" }, { "code": "00781-3244-94", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1483.31, "discounted_cash": 741.66, "minimum": 0.88, "maximum": 0.90, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.90, "methodology": "fee schedule" }, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 2.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 35.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 35.71, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 35.71, "methodology": "percent of total billed charges" } ] } ] }, { 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66.63, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 65.32, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": 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"standard_charge_percentage": 80.0, "estimated_amount": 10443.49, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 10443.49, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 136.43, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 136.43, "methodology": "fee schedule" } ] } ] }, { "description": "Ifosfamide 1gm iv sol", "drug_information": { "unit": "20.00", "type": "ML" }, "code_information": [ { "code": "J9208", "type": "HCPCS" }, { "code": "00143-9531-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 136.68, "discounted_cash": 68.34, "minimum": 28.81, "maximum": 28.81, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 109.34, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", 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1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 74.40, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Leuprolide 30 mg/4 months im inj er", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "00074-3683-03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18544.03, "discounted_cash": 9272.02, "minimum": 113.69, "maximum": 184.41, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 184.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 184.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 184.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 184.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11126.39, "methodology": 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184.41, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 22253.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 22253.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 22253.17, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3708.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3708.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 180.79, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 180.79, "methodology": "fee schedule" } ] } ] }, { "description": "Lurbinectedin 4 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J9223", "type": "HCPCS" }, { "code": "68727-0712-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17517.60, "discounted_cash": 8758.80, "minimum": 204.90, "maximum": 209.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 204.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 209.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 209.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 204.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 204.90, "methodology": "fee schedule" }, { "payer_name": 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"standard_charge_dollar": 183.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 183.65, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 180.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 180.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 180.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 180.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 62586.43, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", 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schedule" } ] } ] }, { "description": "Mitoxantrone 2 mg/ml sol 10ml", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "J9293", "type": "HCPCS" }, { "code": "00703-4685-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 397.80, "discounted_cash": 198.90, "minimum": 28.81, "maximum": 62.04, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 62.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 62.04, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 318.24, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 318.24, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 318.24, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 60.82, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 60.82, "methodology": "fee schedule" } ] } ] }, { "description": "Nivolumab-relatlimab rmbw 240 mg-80 mg/20 ml inj sol", "drug_information": { "unit": "20.00", "type": "ML" }, "code_information": [ { "code": "J9298", "type": "HCPCS" }, { "code": "00003-7125-11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32658.29, "discounted_cash": 16329.15, "minimum": 197.84, "maximum": 201.80, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 201.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 201.80, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 26126.63, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 26126.63, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 26126.63, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 197.84, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 197.84, "methodology": "fee schedule" } ] } ] }, { "description": "Nivolumab 240 mg/24 ml sol", "drug_information": { "unit": "24.00", "type": "ML" }, "code_information": [ { "code": "J9299", "type": "HCPCS" }, { "code": "00003-3734-13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17156.88, "discounted_cash": 8578.44, "minimum": 12.12, "maximum": 32.95, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 32.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 32.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 13725.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 13725.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 13725.50, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 32.30, "methodology": "fee schedule" } ] } ] }, { "description": "Nivolumab 40 mg/4 ml sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": [ { "code": "J9299", "type": "HCPCS" }, { "code": "00003-3772-11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2859.55, "discounted_cash": 1429.78, "minimum": 12.12, "maximum": 32.95, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", 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"plan_name": "29046131", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2287.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2287.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2287.64, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 32.30, "methodology": "fee schedule" } ] } ] }, { "description": "Nivolumab 100 mg/10 ml sol", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "J9299", "type": "HCPCS" }, { "code": "00003-3774-12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7148.70, "discounted_cash": 3574.35, "minimum": 12.12, "maximum": 32.95, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 32.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 32.95, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 5718.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 5718.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 5718.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 32.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 32.30, "methodology": "fee schedule" } ] } ] }, { "description": "Obinutuzumab 1000 mg/40 ml sol", "drug_information": { "unit": "40.00", "type": "ML" }, "code_information": 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schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 74.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 76.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 76.33, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 74.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 74.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 74.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 74.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", 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"29046253", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 89.28, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", 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"payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 5.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 5.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 5.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", 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Medicare", "plan_name": "29046178", "standard_charge_dollar": 16.51, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 11785.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 16.19, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 11785.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 11785.74, "methodology": "percent of total billed charges" }, { "payer_name": 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"methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 28.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 72.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 74.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 74.37, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 72.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": 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72.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 12966.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 12966.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 72.91, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 72.91, "methodology": "fee schedule" } ] } ] }, { "description": "Rituximab 100 mg/10 ml iv sol", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "J9312", "type": "HCPCS" }, { "code": "50242-0051-21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2029.32, "discounted_cash": 1014.66, "minimum": 56.84, "maximum": 78.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl 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Eldercare", "plan_name": "29046164", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1623.46, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", 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56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 76.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 78.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 78.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", 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Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 76.73, "methodology": "fee schedule" } ] } ] }, { "description": "Sacituzumab govitecan hziy 180 mg rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "J9317", "type": "HCPCS" }, { "code": "55135-0132-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5428.60, "discounted_cash": 2714.30, "minimum": 35.44, "maximum": 36.15, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 35.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 36.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 36.15, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 35.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 35.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 35.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 35.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4342.88, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 35.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 35.44, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 35.44, "methodology": "fee 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schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 77.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 78.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 78.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 77.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 77.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 77.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 77.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", 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"standard_charge_dollar": 6.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 6.66, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3350.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3350.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 6.66, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 6.66, "methodology": "fee schedule" } ] } ] }, { "description": "Fulvestrant 250 mg/5 ml im inj", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": 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"36347772", "standard_charge_dollar": 357.69, "methodology": "fee schedule" } ] } ] }, { "description": "Casirivi and imdevi inj", "code_information": [ { "code": "M0243", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1125.00, "discounted_cash": 562.50, "minimum": 459.75, "maximum": 468.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 900.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { 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"type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1125.00, "discounted_cash": 562.50, "minimum": 459.75, "maximum": 468.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl 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Medicare", "plan_name": "29046215", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 900.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 900.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 459.75, "methodology": "fee schedule" } ] } ] }, { "description": "Bamlan and etesev infusion", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 690.00, "discounted_cash": 345.00, "minimum": 459.75, "maximum": 468.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 552.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 552.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 552.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 459.75, "methodology": "fee schedule" } ] } ] }, { "description": "M0245 bamlan-etesev infuse", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 690.00, "discounted_cash": 345.00, "minimum": 459.75, "maximum": 468.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 552.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 552.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 552.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 459.75, "methodology": "fee schedule" } ] } ] }, { "description": "M0247 - iv infusion sotrovimab", "code_information": [ { "code": "M0247", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1043.00, "discounted_cash": 521.50, "minimum": 459.75, "maximum": 468.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 459.75, "methodology": "fee schedule" } ] } ] }, { "description": "Sotrovimab infusion", "code_information": [ { "code": "M0247", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1043.00, "discounted_cash": 521.50, "minimum": 459.75, "maximum": 468.94, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 468.94, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 834.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 459.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 459.75, "methodology": "fee schedule" } ] } ] }, { "description": "Cryo ahf", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 129.00, "discounted_cash": 64.50, "minimum": 64.87, "maximum": 3239.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 66.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 66.17, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 103.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 64.87, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 64.87, "methodology": "fee schedule" } ] } ] }, { "description": "Cryoprecipitate each unit", "code_information": [ { "code": "P9012", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 129.00, "discounted_cash": 64.50, "minimum": 64.87, "maximum": 3239.91, 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"standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 189.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 189.45, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": 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"Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 185.74, "methodology": "fee schedule" } ] } ] }, { "description": "Rbc leukocytes reduced", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 402.00, "discounted_cash": 201.00, "minimum": 185.74, "maximum": 3239.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 185.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 185.74, "methodology": "fee 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"payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 87.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 86.02, "methodology": "fee schedule" } ] } ] }, { "description": "Plasma 1 donor frz w/in 8 hr", "code_information": [ { "code": "P9017", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 402.00, "discounted_cash": 201.00, "minimum": 86.02, "maximum": 3239.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 87.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 87.74, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 86.02, "methodology": "fee 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"payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 86.02, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 86.02, "methodology": "fee schedule" } ] } ] }, { "description": "Aph rbc cp2d as3 lr 2", "code_information": [ { "code": 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Medicare", "plan_name": "29046303", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 79.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 79.07, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", 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"estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 77.52, "methodology": "fee schedule" } ] } ] }, { "description": "Platelets each unit", "code_information": [ { "code": "P9019", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 402.00, "discounted_cash": 201.00, "minimum": 77.52, "maximum": 3239.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": 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"payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 77.52, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 321.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 77.52, "methodology": 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{ "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 497.10, "methodology": "fee schedule" } ] } ] }, { "description": "Platelet pheres leukoreduced", "code_information": [ { "code": "P9035", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 857.00, "discounted_cash": 428.50, "minimum": 497.10, "maximum": 3239.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl 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Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 497.10, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 685.60, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": 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"payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 261.05, "methodology": "fee schedule" } ] } ] }, { "description": "Rbc leukoreduced irradiated", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 525.00, "discounted_cash": 262.50, "minimum": 261.05, "maximum": 3239.91, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 2817.24, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1971.90, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 2394.57, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 3239.91, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 266.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 266.27, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 420.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 261.05, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 261.05, "methodology": "fee schedule" } ] } ] }, { "description": "Albumin human 5% iv sol 250ml", "drug_information": { "unit": "250.00", "type": "ML" }, "code_information": [ { "code": "P9045", "type": "HCPCS" }, { "code": "44206-0310-25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 168.20, 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"Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1301.86, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1301.86, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 26.26, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 26.26, "methodology": "fee schedule" } ] } ] }, { "description": "Epoetin alfa epbx 3000 units/ml preservative-free sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5105", "type": "HCPCS" }, { "code": "00069-1306-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 123.10, "discounted_cash": 61.55, "minimum": 0.75, "maximum": 1.14, 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"standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 98.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 98.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 98.48, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.75, "methodology": "fee schedule" } ] } ] }, { "description": "Epoetin alfa epbx 4000 units/ml preservative-free sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5105", "type": "HCPCS" }, { "code": "00069-1307-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 153.53, "discounted_cash": 76.77, "minimum": 0.75, "maximum": 1.14, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 1.14, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.77, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 122.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 122.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 122.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.75, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.75, "methodology": "fee schedule" } ] } ] }, { "description": "Epoetin alfa epbx 10000 units/ml preservative-free sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5106", "type": "HCPCS" }, { "code": "00069-1308-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 277.96, "discounted_cash": 138.98, "minimum": 7.47, "maximum": 12.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 7.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 7.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 222.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 222.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 222.37, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 7.47, "methodology": "fee schedule" } ] } ] }, { "description": "Epoetin alfa epbx 40000 units/ml preservative-free sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5106", "type": "HCPCS" }, { "code": "00069-1309-04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 952.99, "discounted_cash": 476.50, "minimum": 7.47, "maximum": 12.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 7.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 7.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 762.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 762.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 762.39, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 7.47, "methodology": "fee schedule" } ] } ] }, { "description": "Epoetin alfa epbx 20000 units/ml sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5106", "type": "HCPCS" }, { "code": "00069-1311-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 516.20, "discounted_cash": 258.10, "minimum": 7.47, "maximum": 12.12, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 12.12, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 7.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 7.62, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 412.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 412.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 412.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 7.47, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 7.47, "methodology": "fee schedule" } ] } ] }, { "description": "Bevacizumab-awwb 100 mg/4 ml (mvasi) iv sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": [ { "code": "Q5107", "type": "HCPCS" }, { "code": "55513-0206-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1507.10, "discounted_cash": 753.55, "minimum": 28.73, "maximum": 56.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 29.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 29.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1205.68, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1205.68, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1205.68, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 28.73, "methodology": "fee schedule" } ] } ] }, { "description": "Bevacizumab-awwb 400 mg/16 ml (mvasi) iv sol", "drug_information": { "unit": "16.00", "type": "ML" }, "code_information": [ { "code": "Q5107", "type": "HCPCS" }, { "code": "55513-0207-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6028.42, "discounted_cash": 3014.21, "minimum": 28.73, "maximum": 56.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 29.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 29.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4822.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4822.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4822.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 28.73, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 28.73, "methodology": "fee schedule" } ] } ] }, { "description": "Pegfilgrastim jmdb (fulphilla) 6 mg/0.6 ml (fulphila) sol", "drug_information": { "unit": "0.60", "type": "ML" }, "code_information": [ { "code": "Q5108", "type": "HCPCS" }, { "code": "83257-0005-41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4509.00, "discounted_cash": 2254.50, "minimum": 113.69, "maximum": 127.81, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 127.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 127.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 3607.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 3607.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 3607.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 125.30, "methodology": "fee schedule" } ] } ] }, { "description": "Pegfilgrastim jmdb (fulphilla) 6 mg/0.6 ml (fulphila) sol", "drug_information": { "unit": "0.60", "type": "ML" }, "code_information": [ { "code": "Q5108", "type": "HCPCS" }, { "code": "67457-0833-06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9018.00, "discounted_cash": 4509.00, "minimum": 113.69, "maximum": 127.81, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 127.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 127.81, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 125.30, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 125.30, "methodology": "fee schedule" } ] } ] }, { "description": "Filgrastim aafi 300 mcg/0.5 ml (nivestym) sol", "drug_information": { "unit": "0.50", "type": "ML" }, "code_information": [ { "code": "Q5110", "type": "HCPCS" }, { "code": "00069-0291-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 512.46, "discounted_cash": 256.23, "minimum": 0.29, "maximum": 0.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 409.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 409.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 409.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.29, "methodology": "fee schedule" } ] } ] }, { "description": "Filgrastim aafi 300 mcg/0.5 ml (nivestym) sol", "drug_information": { "unit": "0.50", "type": "ML" }, "code_information": [ { "code": "Q5110", "type": "HCPCS" }, { "code": "00069-0291-10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 512.46, "discounted_cash": 256.23, "minimum": 0.29, "maximum": 0.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 409.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 409.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 409.97, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.29, "methodology": "fee schedule" } ] } ] }, { "description": "Filgrastim aafi 480 mcg/0.8 ml (nivestym) sol", "drug_information": { "unit": "0.80", "type": "ML" }, "code_information": [ { "code": "Q5110", "type": "HCPCS" }, { "code": "00069-0292-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 777.89, "discounted_cash": 388.95, "minimum": 0.29, "maximum": 0.50, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 0.50, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.30, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 622.31, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 622.31, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 622.31, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.29, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.29, "methodology": "fee schedule" } ] } ] }, { "description": "Pegfilgrastim-cbqv 6 mg/0.6 ml (udenyca) sol", "drug_information": { "unit": "0.60", "type": "ML" }, "code_information": [ { "code": "Q5111", "type": "HCPCS" }, { "code": "70114-0101-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9018.00, "discounted_cash": 4509.00, "minimum": 113.69, "maximum": 138.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 138.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 138.26, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 135.55, "methodology": "fee schedule" } ] } ] }, { "description": "Pegfilgrastim cbqv (udenyca) 6 mg/0.6 ml sol on-body", "drug_information": { "unit": "0.60", "type": "ML" }, "code_information": [ { "code": "Q5111", "type": "HCPCS" }, { "code": "70114-0120-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9018.00, "discounted_cash": 4509.00, "minimum": 113.69, "maximum": 138.26, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 113.69, "methodology": "fee schedule" }, { "payer_name": "Tahl 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"methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7214.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 135.55, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 135.55, "methodology": "fee schedule" } ] } ] }, { "description": "Trastuzumab dkst 420 mg (ogivri) rec", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5114", "type": "HCPCS" }, { "code": "67457-0847-44", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7986.08, "discounted_cash": 3993.04, "minimum": 51.84, "maximum": 56.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 52.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 52.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", 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"standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 52.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 52.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1625.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1625.20, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1625.20, "methodology": "percent of total billed charges" }, { "payer_name": 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56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 52.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 52.88, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4536.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4536.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4536.09, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 51.84, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 51.84, "methodology": "fee schedule" } ] } ] }, { 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116.56, "discounted_cash": 58.28, "minimum": 31.83, "maximum": 56.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 32.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 32.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 93.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 93.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 93.25, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 31.83, "methodology": "fee schedule" } ] } ] }, { "description": "Rituximab-abbs 500mg/50ml (truxima) iv sol", "drug_information": { "unit": "50.00", "type": "ML" }, "code_information": [ { "code": "Q5115", "type": "HCPCS" }, { "code": "63459-0104-50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9132.30, "discounted_cash": 4566.15, "minimum": 31.83, "maximum": 56.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", 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"payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 7305.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 31.83, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 7305.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 7305.84, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 31.83, "methodology": 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Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 18.97, "methodology": "fee schedule" } ] } ] }, { "description": "Trastuzumab qyyp 150 mg (trazimera) rec", "drug_information": { "unit": "1.00", "type": "UN" }, "code_information": [ { "code": "Q5116", "type": "HCPCS" }, { "code": "00069-0308-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2615.98, "discounted_cash": 1307.99, "minimum": 18.97, "maximum": 19.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 18.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 19.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 19.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 18.97, 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"methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 18.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 18.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 18.97, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2092.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2092.78, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 18.97, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", 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"plan_name": "29046303", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 35.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 35.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 2350.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 2350.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 2350.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 34.69, "methodology": "fee schedule" } ] } ] }, { "description": "Trastuzumab-anns 420 mg (kanjinti) rec", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5117", "type": "HCPCS" }, { "code": "55513-0164-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8225.68, "discounted_cash": 4112.84, "minimum": 34.69, "maximum": 56.84, "setting": "both", "payers_information": [ { "payer_name": "Tahl Bcbs Advantage", "plan_name": "29030860", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Choice", "plan_name": "29030731", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Cn", "plan_name": "29030748", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Lincs", "plan_name": "29030808", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Preferred", "plan_name": "29030781", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Bcbs Traditional", "plan_name": "29030835", "standard_charge_dollar": 56.84, "methodology": "fee schedule" }, { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 35.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 35.38, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6580.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6580.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6580.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 34.69, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 34.69, "methodology": "fee schedule" } ] } ] }, { "description": "Bevacizumab bvzr 100 mg/4 ml (zirabev) sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": [ { "code": "Q5118", "type": "HCPCS" }, { "code": "00069-0315-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1324.94, "discounted_cash": 662.47, "minimum": 23.00, "maximum": 23.46, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 23.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 23.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1059.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1059.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1059.95, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 23.00, "methodology": "fee schedule" } ] } ] }, { "description": "Bevacizumab bvzr 400 mg/16 ml (zirabev) sol", "drug_information": { "unit": "16.00", "type": "ML" }, "code_information": [ { "code": "Q5118", "type": "HCPCS" }, { "code": "00069-0342-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5299.78, "discounted_cash": 2649.89, "minimum": 23.00, "maximum": 23.46, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 23.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 23.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4239.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4239.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4239.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 23.00, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 23.00, "methodology": "fee schedule" } ] } ] }, { "description": "Rituximab pvvr 100 mg/10ml (ruxience) sol", "drug_information": { "unit": "10.00", "type": "ML" }, "code_information": [ { "code": "Q5119", "type": "HCPCS" }, { "code": "00069-0238-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1548.36, "discounted_cash": 774.18, "minimum": 23.59, "maximum": 24.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 24.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 24.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1238.69, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1238.69, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1238.69, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 23.59, "methodology": "fee schedule" } ] } ] }, { "description": "Rituximab pvvr 500 mg/ 50ml (ruxience) sol", "drug_information": { "unit": "50.00", "type": "ML" }, "code_information": [ { "code": "Q5119", "type": "HCPCS" }, { "code": "00069-0249-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7741.80, "discounted_cash": 3870.90, "minimum": 23.59, "maximum": 24.06, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 24.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 24.06, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6193.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6193.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6193.44, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 23.59, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 23.59, "methodology": "fee schedule" } ] } ] }, { "description": "Pegfilgrastim bmez 6 mg/0.6 ml (ziextenzo) sol", "drug_information": { "unit": "0.60", "type": "ML" }, "code_information": [ { "code": "Q5120", "type": "HCPCS" }, { "code": "61314-0866-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8479.15, "discounted_cash": 4239.58, "minimum": 24.71, "maximum": 25.20, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 25.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 25.20, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6783.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6783.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6783.32, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 24.71, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 24.71, "methodology": "fee schedule" } ] } ] }, { "description": "Pegfilgrastim apgf 6 mg/0.6 ml (nyvepria) inj sol", "drug_information": { "unit": "0.60", "type": "ML" }, "code_information": [ { "code": "Q5122", "type": "HCPCS" }, { "code": "00069-0324-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8478.00, "discounted_cash": 4239.00, "minimum": 117.01, "maximum": 119.35, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 119.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 119.35, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6782.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6782.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6782.40, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 117.01, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 117.01, "methodology": "fee schedule" } ] } ] }, { "description": "Filgrastim ayow 300 mcg/ml (releuko) inj sol", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q5125", "type": "HCPCS" }, { "code": "70121-1569-07", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 400.68, "discounted_cash": 200.34, "minimum": 0.46, "maximum": 0.47, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 320.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 320.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 320.54, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.46, "methodology": "fee schedule" } ] } ] }, { "description": "Filgrastim ayow 480 mcg/0.8 ml(releuko) inj sol", "drug_information": { "unit": "0.80", "type": "ML" }, "code_information": [ { "code": "Q5125", "type": "HCPCS" }, { "code": "70121-1570-07", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 580.03, "discounted_cash": 290.02, "minimum": 0.46, "maximum": 0.47, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 0.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 0.47, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 464.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 464.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 464.02, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 0.46, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 0.46, "methodology": "fee schedule" } ] } ] }, { "description": "Bevacizumab maly 100 mg/4ml (alymsys) sol", "drug_information": { "unit": "4.00", "type": "ML" }, "code_information": [ { "code": "Q5126", "type": "HCPCS" }, { "code": "70121-1754-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1552.18, "discounted_cash": 776.09, "minimum": 59.43, "maximum": 60.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 60.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 60.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 1241.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 1241.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 1241.74, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 59.43, "methodology": "fee schedule" } ] } ] }, { "description": "Bevacizumab maly 400 mg/16ml (alymsys) sol", "drug_information": { "unit": "16.00", "type": "ML" }, "code_information": [ { "code": "Q5126", "type": "HCPCS" }, { "code": "70121-1755-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6208.70, "discounted_cash": 3104.35, "minimum": 59.43, "maximum": 60.61, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 60.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 60.61, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4966.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4966.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4966.96, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 59.43, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 59.43, "methodology": "fee schedule" } ] } ] }, { "description": "Pegfilgrastim pbbk 6 mg/0.6 ml (fylnetra) inj sol", "drug_information": { "unit": "0.60", "type": "ML" }, "code_information": [ { "code": "Q5130", "type": "HCPCS" }, { "code": "70121-1627-01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5400.00, "discounted_cash": 2700.00, "minimum": 187.29, "maximum": 191.03, "setting": "both", "payers_information": [ { "payer_name": "Tahl Cc Medicare", "plan_name": "29046303", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Commercial", "plan_name": "29045832", "standard_charge_dollar": 191.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Humana Medicare", "plan_name": "29046178", "standard_charge_dollar": 191.03, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare", "plan_name": "29046131", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Advantage", "plan_name": "29739437", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Medicare Replacement", "plan_name": "29046253", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous Medicare", "plan_name": "28186619", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 4320.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Pace Eldercare", "plan_name": "29046164", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Railroad Medicare", "plan_name": "30770134", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare", "plan_name": "29043841", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare East", "plan_name": "30770242", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Tricare For Life", "plan_name": "30770266", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Medicare", "plan_name": "29046215", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 4320.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 4320.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Veterans Administration", "plan_name": "29042596", "standard_charge_dollar": 187.29, "methodology": "fee schedule" }, { "payer_name": "United Health Care Dual Complete Medicare", "plan_name": "36347772", "standard_charge_dollar": 187.29, "methodology": "fee schedule" } ] } ] }, { "description": "Sulfur hexafluoride lipid-a rec 60.7 mg", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q9950", "type": "HCPCS" }, { "code": "00270-7097-07", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 366.03, "discounted_cash": 183.02, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 292.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 292.82, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 292.82, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sulfur hexafluoride lipid-a rec 60.7 mg", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q9950", "type": "HCPCS" }, { "code": "00270-7097-08", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.48, "discounted_cash": 30.24, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 48.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 48.38, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 48.38, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Sulfur hexafluoride lipid-a rec 60.7 mg", "drug_information": { "unit": "1.00", "type": "ML" }, "code_information": [ { "code": "Q9950", "type": "HCPCS" }, { "code": "00270-7099-16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 358.09, "discounted_cash": 179.05, "setting": "both", 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"methodology": "percent of total billed charges" } ] } ] }, { "description": "Amniotic membrane", "code_information": [ { "code": "V2790", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 8400.00, "discounted_cash": 4200.00, "setting": "both", "payers_information": [ { "payer_name": "Tahl Miscellaneous United Healthcare", "plan_name": "28186640", "standard_charge_percentage": 80.0, "estimated_amount": 6720.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl Uhc Shared Services", "plan_name": "29042477", "standard_charge_percentage": 80.0, "estimated_amount": 6720.00, "methodology": "percent of total billed charges" }, { "payer_name": "Tahl United Healthcare", "plan_name": "29045755", "standard_charge_percentage": 80.0, "estimated_amount": 6720.00, "methodology": "percent of total billed charges" } ] } ] }, { "description": "Amniotic membrane pallingen 4x4 xm-020404", "code_information": [ { "code": "V2790", "type": "HCPCS" } ], "standard_charges": 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